The American journal of emergency medicine
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Comparative Study
ED length-of-stay and illness severity in dizzy and chest-pain patients.
Emergency department (ED) length of stay, illness severity, and patterns of ED-based testing can be used to compare different ED patient populations. To assess the relative significance of ED patients with dizziness and chest pain in emergency medicine practice, the investigators formed a retrospective chart review of 3,864 adults (age > or = 16 years) seen at the University of North Carolina Hospitals' ED during May and June of 1991. Patients were eligible if they had any complaint of dizziness (n = 259), nontraumatic chest pain (n = 168), or both (n = 18). ⋯ Chest-pain patients were more likely to undergo electrocardiogram and x-ray testing, whereas dizzy patients more often received testing such as brain computed tomography scanning (10.8% v 3.6%, P = .01). ED patients with dizziness and chest pain were similar with regard to ED length of stay. Given their overall similarities to the chest-pain group, dizzy patients appear to represent a significant population of ED patients and may warrant more clinical study.
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This prospective, clinical study was performed to determine the utility of the syringe aspiration technique (SAT) to verify endotracheal tube (ETT) position. Ninety consecutive patients requiring urgent intubation in the emergency department or prehospital setting were enrolled in the study. ⋯ Ultimately, standard detection techniques were used to confirm ETT placement. The SAT was an accurate means of verifying ETT placement.
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To determine the incidence of life-threatening hypotension (LTH) suffered by patients in the initial hours after emergency intubation and mechanical ventilation, prospective, consecutive case series of patients undergoing endotracheal intubation and mechanical ventilation were evaluated in the adult emergency department of a large urban hospital. Eight-four medical patients who received intubation and mechanical ventilation for ventilatory failure, respiratory failure, or airway protection (trauma patients exluded) were included. LTH, defined as a decrease in mean arterial pressure of 60 mm Hg or an absolute decrease to a systolic blood pressure < 80 mm Hg in the first 2 hours after intubation, was observed in 24 of the 84 patients who met study criteria (incidence 28.6%). ⋯ No association could be established between LTH and the other diagnoses, arterial blood gas (ABG) derangements, or the administration of sedatives or paralytic medications. LTH represents a serious complication of emergency intubation in the initial phase of mechanical ventilation. Because it occurs in more one quarter of all cases, it should be anticipated during intubation and the initial phase of ventilator management, especially in high-risk patients such as those with hypercarbic COPD.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cocaine and ethanol abuse remains a major problem in our society. The active metabolite of the co-ingestion of cocaine and ethanol, cocaethylene, has been reported recently. This active and potentially toxic metabolite has enormous implications for emergency physicians. This article is a brief review of the current understanding of cocaethylene and its role as a serious toxin in the practice of emergency medicine.
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Nine consecutive patients presenting with acute gouty arthritis were treated with ketorolac 60 mg intramuscularly (IM). The average age was 58. Seven were male, and six were black. ⋯ There were no side effects of the medication. All of the patients were able to leave the treatment area satisfied with their treatment. None of the patients required crutches at discharge.