Emergency medicine clinics of North America
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In summary, I have examined the questions of why have a trauma care system and whether trauma care systems improve trauma care. I believe the evidence is overwhelming that trauma care systems are worthwhile and that they improve trauma care. ⋯ Trauma care systems should also be integral to the regional disaster plans and to the education of the public and should be a focus for research activities in trauma care. All trauma centers should provide access to rehabilitation services so that the patient who recovers from acute injuries can return to a productive life.
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Injury to the chest accounts directly or indirectly for up to 50 per cent of deaths secondary to trauma. Eighty-five per cent of patients with chest injury may be managed by minor procedures available to the emergency physician. The indications for surgery in the remaining 15 per cent of patients with chest injury must be understood.
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This article focuses on some of the more common dangerous plant and mushroom ingestions, discussing toxic components, early symptoms, and treatment. Among the plants considered are oleander, foxglove, hemlock, dieffenbachia, and Amanita phalloides. Details concerning recognition of toxic species are intentionally omitted in an effort to avoid potentially dangerous errors in identification.
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Cold injuries, hypothermia, and frostbite are discussed, including the pathophysiology, clinical presentation, and modern management.
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Submersion injuries are a relatively common problem for emergency physicians. The primary physiologic problem in these patients is hypoxemia, and virtually all complications are secondary to this. ⋯ Despite prompt and vigorous resuscitation, though, residual neurologic deficits and deaths continue to occur after submersion injury. Clearly, prevention is the most important factor in reducing the morbidity and mortality from these injuries.