Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · May 2003
ReviewEnvironmental insults: smoke inhalation, submersion, diving, and high altitude.
In the expanding search for recreation, we spend more and more of our time in various environments. Whether the air is thin or compressed or smoke-filled or there is no air at all, emergency physicians continue to meet and treat the various pulmonary emergencies that the environment may create. The authors present the background, diagnosis, and management of a few of the more common pulmonary emergencies that the environment may produce.
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Pulmonary edema is differentiated into two categories--cardiogenic and noncardiogenic. Noncardiogenic pulmonary edema is due to changes in permeability of the pulmonary capillary membrane as a result of either a direct or an indirect pathologic process. ⋯ Newer ventilation techniques, such as high-frequency oscillatory ventilation and partial fluid ventilation, are promising but are in the early stages of clinical testing. Mortality rates remain high despite increasing intensive care unit care.
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Emerg. Med. Clin. North Am. · May 2003
ReviewPulmonary trauma emergency department evaluation and management.
Pulmonary trauma is a significant cause of morbidity and mortality in the United States. It is imperative for the emergency physician to identify promptly patients who require immediate therapy. ⋯ This rise in respiratory injuries will require a more aggressive approach of patients with minimal morbidity and mortality. A systematic approach to respiratory injuries is crucial to improving patient outcomes.
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Emerg. Med. Clin. North Am. · May 2003
ReviewManagement of the difficult airway: alternative airway techniques and adjuncts.
Rapid-sequence intubation using conventional laryngoscopic technique remains the standard of airway management in emergency medicine and continues to have a success rate of approximately 98%. Preparation and proper intubation technique must be optimized at the initial attempt using direct laryngoscopy. Failure causes multiple repeated attempts, leading to a failed airway. ⋯ Without proper technique, even with proper positioning, the glottic opening cannot be visualized. Laryngeal pressure to maneuver the larynx into position should be exerted initially by the laryngoscopist's right hand and, when in view, maintained by an assistant to free the laryngoscopist's hand for ETT insertion. With preparation and proper technique, the first attempt is the best attempt, and the vicious cycle of multiple attempts and complications will be averted.
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The lungs can be an efficient means for the absorption of inhaled toxicants, resulting in airway and pulmonary injury or systemic toxicity. Although a few specific antidotes exist for inhaled toxicants, the syndrome of acute inhalation injury and clinical therapeutics are linked by common pathways of pathophysiology. Understanding the mechanisms of inhalation injury and occupation- or situation-specific toxicants can simplify the decision-making process for the out-of-hospital emergency responder and the emergency physician when confronted with a patient and the myriad of potential inhaled toxicants.