The American journal of emergency medicine
-
There is no consensus on what constitutes appropriate field airway management in the seriously injured semiconscious patient. The respiratory complications in a selected group of patients who were transported from the scene of an accident by a helicopter service whose policy was to perform endotracheal intubation on only deeply obtunded patients and manage others with bag mask ventilation are reported. Respiratory compromise was defined as follows: partial pressure of oxygen less than 65 torr on initial hospital arterial blood gases, partial pressure of carbon dioxide greater than 45 torr on initial hospital arterial blood gases, or radiographic and clinical evidence of aspiration pneumonitis within 5 days of admission to the hospital. ⋯ Ten of these patients ha adequate perfusion and abnormal arterial blood gases after arrival at the receiving hospital. Five patients might have benefited from endotracheal intubation in the field, but there were no preventable deaths. Neurologic status of the patient appeared to be more useful than respiratory status in predicting respiratory compromise.
-
Review Case Reports
Emergency department management of retained rectal foreign bodies.
A plastic toothbrush case was removed from the rectum of a prison inmate in the emergency department using a rigid sigmoidoscope and a fogarty catheter. The patient was subsequently discharged from the emergency department. Previous literature regarding rectal foreign bodies has emphasized inpatient treatment and tended to ignore the potential value of the emergency service. Guidelines for selecting appropriate patients for emergency department management are presented and basic principles for safe outpatient removal are reviewed.
-
Out-of-hospital cardiac arrests were studied in Israel from 1984 to 1985. More than 3,500 patients in cardiac arrest received paramedic care. Eighty-three percent of cases were caused by underlying heart disease. ⋯ There was a wide variation in the percent discharged among the 15 paramedic service areas, ranging from 0% to 13%. Factors associated with successful resuscitation included witnessed collapse, rhythm of ventricular fibrillation, short interval from collapse to cardiopulmonary resuscitation (CPR) and delivery of advanced cardiac life support, collapse at public location, and bystander initiation of CPR. Improvements in survival are likely to result if CPR is more frequently and promptly initiated and the time to arrival of definitive paramedic care can be improved.
-
The developing countries of the world represent a new environment in which to apply the unique expertise and knowledge of emergency medicine. With an understanding of the cultural, political and economic forces that affect health care in developing countries, American emergency physicians should consider collaboration with their counterparts in developing countries in such areas as prehospital care systems, trauma care, disaster management, poison information and management systems, and education related to clinical services, administration, and research methods in emergency medicine. Such collaboration can broaden the field of emergency medicine and fulfill individual humanitarian goals.