Emergency medicine clinics of North America
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Fractures in the hand, as elsewhere, usually fall into identifiable patterns. With prompt diagnosis and appropriate management, most fractures can be treated satisfactorily by closed means. However, a small percentage of fractures in the hand do require treatment by open means. Early recognition and early treatment of these injuries will usually avoid significant complications.
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This article presents a general approach to the patient with community-acquired pneumonia and details clinical and therapeutic features of the principal community-acquired pneumonias: pneumococcal pneumonia, mycoplasma pneumonia, and legionnaires disease.
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The past two decades have been a period of increased concern over the improvement of prehospital emergency medical care. Training of basic and advanced EMTs to a level of professionalism that includes a distinct body of knowledge and the use of assessment and management skills is only one component of the prehospital system. ⋯ The management of the trauma victim is an organized plan of controlling the airway, restoring breathing, and supporting ventilation, followed by a secondary survey of the less life-threatening problems. The role of EMTs or paramedics, therefore, is to assess, manage, extricate, and transport.
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It has been estimated that one fourth to one third of the deaths from trauma could be prevented by more effective initial care. The majority of traumatized patients who present to the emergency department do not have life-threatening injuries and may be assessed in an orderly manner. Roughly 10 per cent of patients will have life-threatening injuries, however, and speed in assessment, diagnosis, and therapy is crucial to their survival.
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Maxillofacial injuries are frequent, often dramatic, and easily divert attention from more occult injuries. Early consultation with the plastic surgeon will enable the traumatologist to formulate an integrated, definitive plan that will produce superior aesthetic and functional results.