Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · May 1994
Review Case ReportsSpecial considerations in the poisoned pediatric patient.
The incidence of serious pediatric morbidity and mortality has fortunately declined over the past two decades due to better prevention efforts, the development of regionalized poison information programs, and advances in the emergency management and critical care of poisoned patients. Still, children continue to explore and often ingest many substances they discover in their world. ⋯ Management strategies including decontamination, urgent antidotal therapy, initiation of excretion enhancement, and optimal supportive care were reviewed. Several specific intoxications were illustrated briefly in an attempt to facilitate pattern recognition of characteristic pediatric exposures.
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Emerg. Med. Clin. North Am. · May 1994
ReviewEmergency department response to hazardous materials incidents.
Emergency physicians must stay alert to situations that involve toxic chemical exposures. An appropriate response to victims of chemical contamination is important for the victim's outcome and the safety of hospital personnel. ⋯ Chemical contamination may affect one or hundreds of victims. Community planning is essential for an effective response to toxic chemical accidents (Haz-Mat).
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HBO has become recognized as a potential treatment for a variety of toxins. HBO is helpful because it provides an excess of dissolved oxygen, which not only can sustain life in the absence of hemoglobin, but in some cases can actually increase the clearance of toxins. In addition, it is now apparent that HBO serves more complex roles in toxicological injuries, such as modifying PMN-endothelial interactions and preventing oxidative tissue injury. ⋯ There is a physiologic basis for use of HBO in the toxins discussed. Unfortunately, only for CO is patient volume adequate for studies to document efficacy. Regarding the other toxins mentioned, the use of HBO should be reserved for carefully selected cases in which patients have failed routine care or are at risk for delayed effects.
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Toxicity from beta-blocker and calcium channel blocker drugs is a challenging medical emergency with steadily increasing incidence. Clinical manifestations of intoxication with these drugs are presented in light of known pharmacologic and pharmacokinetic properties, as well as the physiology of the beta-adrenoreceptor and calcium channel. Review of clinical and basic science literature provides the basis for specific management guidelines for beta-blocker and calcium channel blocker toxicity.
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The care of the pregnant patient presenting to the emergency department with labor or delivery complications requires an understanding of signs and symptoms of disease for the maternal and fetal patient. This article reviews management of common labor and delivery complications that may occur in the emergency department. The management of premature labor, premature rupture of the membranes, emergency delivery procedure, resolution of shoulder dystocia, prolapsed umbilical cord, and perimortem cesarean section are discussed.