The American journal of emergency medicine
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Review Case Reports
Boerhaave's syndrome presenting with abdominal pain and right hydropneumothorax.
This case of Boerhaave's Syndrome had several unusual features including a delayed presentation and right-sided esophageal perforation. The patient's initial episode of hematemesis may have been caused by a small mucosal laceration in the area of the Barrett's lesion that later ruptured. On the other hand, if initially there was an esophageal rupture, it did not violate the parietal pleura or mediastinum. ⋯ The single most important test may be the upright chest X-ray. However, if it is normal, and there is a high index of suspicion, esophagograms and or chest CT may be required to demonstrate the lesion. Because survival is directly related to the time to diagnosis and treatment, a high clinical suspicion can decrease the substantial morbidity and mortality associated with Boerhaave's Syndrome.
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The objective was to determine whether children with a physician parent receive treatment different from that of children of nonphysician parents when they present to the emergency department (ED). The design was a retrospective cohort study. The setting was a university-affiliated children's hospital ED. ⋯ Compared with controls, the most junior member of the medical team seen by children of a physician parent was less likely to be a medical student (relative risk [RR] = 0.22) or a resident (RR = 0.71) and more likely to be an ED staff physician (RR = 1.52) or consultant (RR = 1.84). This trend was statistically significant (P = .002). The children of physician parents are more likely to see only an ED staff physician and/or consultant and less likely to see trainees than other children presenting to the pediatric ED.
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Activation of the emergency medical services (EMS) system does not always result in transport of a patient to the hospital. This study assessed the outcomes of patients who refused medical assistance in the field, to determine if refusal of medical assistance (RMA) is associated with poor outcomes. Four high-volume suburban volunteer ambulance corps participated in the study. ⋯ Even if none of the patients lost to follow-up had sought further care, a substantial number of patients who refuse out-of-hospital medical assistance seek further care. Some of these patients require hospital admission, especially those with cardiac or respiratory complaints. Efforts to minimize RMA should be especially focused on patients with such complaints.
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Bag-valve-mask (BVM) and oxygen-powered demand valve (OPDV) are two available adjuncts for artificial ventilation. Use of OPVDs has been limited by concern for causing or worsening pneumothorax. This study examined the effect of OPDV and BVM ventilation in swine with pneumothorax. ⋯ However, multiple comparisons showed no significant differences between OPDV and BVM at any time points. In this model, OPDV and BVM ventilation did not differ in their effects on pneumothorax volume or hemodynamic variables. No animal showed signs of tension pneumothorax.