The American journal of emergency medicine
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Comparative Study Clinical Trial Controlled Clinical Trial
The knee-chest position does not improve the efficacy of ipecac-induced emesis.
Previous studies have shown that ipecac-induced emesis, even if instituted very early, removes only a mean of 28% to 45% of an ingested tracer. Because vomiting is an ancient reflex that occurs in mammals, reptiles, and other animals, we speculated that, in humans, maintaining a sitting rather than a horizontal posture during induced emesis might decrease the efficacy of gastric emptying. To test this hypothesis, 20 normal fasting adult subjects underwent induced emesis in the knee-chest position on one day and in the sitting position on another. ⋯ This represented 47.1% of the administered tracer dose (95% Cl, 40.1% to 54.0%). Even if initiated only ten minutes after an ingestion, ipecac-induced emesis removes an average of less than half of an ingested tracer dose, with a high degree of intersubject variability. Horizontal patient positioning does not appear to improve the efficacy of this procedure.
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Case Reports
Bilateral hypothenar hammer syndrome: an unusual and preventable cause of digital ischemia.
Unilateral ischemia of hand digits is usually caused by thoracic outlet obstruction, arterial emboli from a cardiac source, or atherosclerosis. The case of a metal press worker with unilateral ischemia due to hypothenar hammer syndrome, a condition caused by the repetitive use of the hypothenar eminence as a hammer with resultant damage to the ulnar artery, is described. ⋯ This patient had used both hands repeatedly to pound the edges of large steel plates and presented with nondominant-hand ischemia, but was found to have the syndrome bilaterally by angiography. The distinctive features of this syndrome, a preventable and treatable cause of digital ischemia, are emphasized.
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A technique to enhance difficult percutaneous radial artery cannulations using Doppler ultrasound is described. A series of 12 patients (nine hypotensive and three normotensive patients with poorly palpable or absent radial pulses) was assembled and the radial arteries were cannulated using standard intravenous catheters and a hand-held Doppler ultrasound device. Localization and cannulation of the arteries was facilitated by noting the characteristic sounds using the Doppler. ⋯ In one case the artery was localized but the catheter could not be advanced. No complications were encountered. It was concluded that the use of a common Doppler ultrasound on selected patients with poor peripheral pulses may facilitate percutaneous radial artery cannulations and minimize the number of catheter punctures before successful placement.
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A patient with chronic renal failure presenting to the emergency department with acute pulmonary edema has a true life-threatening emergency. Whereas conventional treatment modalities may prove useful, more unusual therapeutic measures may be necessary. A case is presented followed by useful recommendations for the emergency physician faced with such a patient.