Emergency medicine clinics of North America
-
Emerg. Med. Clin. North Am. · Feb 1998
ReviewCivilian gunshot wounds and ballistics: dispelling the myths.
This review outlines the foundations of ballistics and provides guidelines for the emergency care of those wounded by gunfire. It also describes the causes of recently increasing misinformation that is confusing and misleading trauma surgeons. Among these causes are an increasing firearm illiteracy, failure of the editorial and peer review in the trauma surgery literature to adequately evaluate wound ballistics papers, and widespread distortions promulgated by gun prohibitionist advocates. Solving these problems requires strict adherence to fundamental scientific method and the basic precepts of academic honesty and scholarly integrity.
-
Emerg. Med. Clin. North Am. · Feb 1998
ReviewReappraising the prehospital care of the patient with major trauma.
Recent research efforts have demonstrated that many long-standing practices for the prehospital resuscitation of trauma patients may be inappropriate, particularly in certain circumstances. Traditional practices, such as application of antishock garments and IV fluid administration, may even be detrimental in certain patients with uncontrolled bleeding. ⋯ If these procedures delay patient transport, any benefit they may offer could be outweighed by delaying definitive care. To improve current systems of trauma care, future trauma research must address the different mechanisms of injury, the anatomic areas involved, and the physiologic staging in a given patient.
-
Emerg. Med. Clin. North Am. · Feb 1998
ReviewManagement of the difficult airway in the trauma patient.
Airway management of the multiple trauma patient presents a series of challenges. By definition, many trauma patients present difficult airways that require a different approach and formulation of a planned series of steps before airway management is initiated. Recognition of specific attributes of the difficult airway, knowledge of appropriate techniques, familiarity with various devices, and prompt recognition of failed airway circumstances are necessary for optimal patient outcome. This article reviews the attributes of the difficult airway, the definition of the failed airway, and devices and techniques to be used in the management of difficult and failed airways in the trauma patient.
-
The availability of bedside ultrasonography can dramatically impact the care of patients with cardiac or aortic injuries. A focused, limited echocardiographic examination in the initial evaluation of victims with thoracic injuries can provide vital information the clinician needs to expedite the management of these patients. This article reviews the current use of transthoracic and transesophageal echocardiography in patients with thoracic trauma.
-
The use of ultrasonography, traditionally performed by radiologists, is becoming increasingly widespread in emergency medicine. Consequently, much debate has evolved over whether emergency medicine physicians are qualified to provide this service, and the criteria by which training and credentialing can be achieved. This article discusses training and credentialing guidelines, paths to becoming credentialed in emergency sonography, and quality assurance issues. Also, strategies are proposed for emergency departments seeking to perform emergency sonography.