The American journal of emergency medicine
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Envenomation by the North American coral snake is an uncommon entity in the United States. In most cases fang marks will be present, although they may be quite small and difficult to see. The case of a young man who demonstrated evidence of envenomation following the bite of a Texas coral snake (Micrurus fulvius tenere), despite the absence of any apparent fang marks on close examination, is reported. The problems associated with coral snake envenomation in terms of diagnosis and management are reviewed.
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To assess how soon rural emergency departments (EDs) call for helicopters to transport seriously injured patients, the records of all trauma victims (excluding isolated CNS trauma) transported by an emergency helicopter service from referring hospitals to a trauma center over an 18-month period were studied. Admission time to the referring ED was compared with the exact time a call for the helicopter was received and a time-to-request interval (TTR) was calculated. A total of 64 cases were studied. ⋯ Children (aged less than or equal to 16 years) had an average TTR of 34.1 minutes compared with 76.4 minutes for adults (aged greater than 16 years). Of the variables examined, patient age was the only factor significantly associated with TTR. These observations suggest that, except in children, there frequently is a lengthy time interval between the time trauma patients arrive at EDs in rural eastern North Carolina and the time an emergency helicopter service is called to transport them to a trauma center.
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A 24-year-old woman ingested an unknown amount of potassium cyanide in a suicide attempt. Coma and metabolic acidosis developed. ⋯ The highest measured methemoglobin level after sodium nitrite administration was 9.2%, demonstrating that attaining a "therapeutic methemoglobin level" of 25% is unnecessary to insure a satisfactory clinical outcome. Because severe hypotension or excessive methemoglobinemia can be caused by the sodium nitrite component of the Lilly kit, only enough to produce an acceptable clinical response should be administered.
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The small quantities of 7.5% hypertonic saline (HTS) in 6% Dextran 70 (DEX 70; Travenol Laboratories, Deerfield, IL) required to produce marked improvement in tissue perfusion may make it an ideal solution for the prehospital management of hypotensive trauma patients. This study shows that the initial treatment of porcine hemorrhagic shock with 7.5% HTS/6% DEX 70 results in significantly improved hemodynamics and higher survival rates than those seen in animals treated with normal saline. These results are very encouraging and dictate the need for evaluation in human trials.
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Since the introduction of sulfonamides in the late 1930s, coalescent mastoiditis is an uncommon complication of otitis media. Swelling, erythema, and tenderness over the mastoid area with associated anterior displacement of the auricle are classic signs and symptoms of coalescent mastoiditis with formation of a subperiosteal abscess. ⋯ Prompt otolaryngologic consultation is indicated and inpatient antibiotic therapy should be begun. Surgical treatment is also needed and may obviate further complications.