The American journal of emergency medicine
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Blunt traumatic rupture of the left ventricle of the heart is rarely diagnosed preoperatively and is usually fatal, with only a few survivors reported in the literature. This report describes a case of a 54-year-old woman who survived a left ventricular rupture from a motor vehicle accident. Her cardiac injury was not suspected because she was not hypotensive and had no signs of pericardial tamponade. She developed circulatory arrest 2 hours after her injury, during induction of anesthesia.
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Pulmonary thromboembolism (PTE) is a common cause of morbidity and mortality in an emergency department patient population. The advent of ventilation/perfusion (V/Q) lung scanning and the more recent publication of well- controlled analysis of results, such as the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) data, have provided the clinician with effective diagnostic algorithms to use in suggestive cases. However, there are disorders other than PTE, such as bronchogenic carcinoma, that can cause characteristic abnormalities in V/Q scanning. One such case is described in this report.
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To describe the simultaneous responses of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), heart rate (HR), shock index (SI = HR/SBP), central venous oxyhemoglobin saturation (ScvO2), and arterial blood lactate concentration (Lact) to resuscitation of critically ill patients in the emergency department (ED), an observational descriptive study was conducted in the ED of an urban teaching hospital. Thirty- six patients admitted from the ED to the medical intensive care unit were studied. Vital signs were measured immediately on arrival to the ED (phase 1). ⋯ It was concluded that additional therapy is required in the majority of critically ill patients to restore adequate systemic oxygenation after initial resuscitation and hemodynamic stabilization in the ED. Additional therapy to increase ScvO2 and decrease Lact may not produce substantial responses in SBP, DBP, MAP, HR, and SI. The measurement of ScvO2 and Lact can be utilized to guide this phase of additional therapy in the ED.
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In suburban and rural counties, patient transport to specialized facilities such as trauma centers may result in prolonged transport times with the resultant loss of ambulance coverage in the primary service area. We evaluated the American College of Surgeons trauma triage criteria as modified by New York State to determine the ability of these criteria to predict the need for trauma center care in victims of blunt traumatic injury. Blunt trauma patients were retrospectively identified through review of patient care reports for the presence either of mechanism or of physiological criteria for transport to a trauma center. ⋯ Patients with physiologic criteria may benefit from transport directly to a trauma center. Because of the low need for operative intervention and ICU services, patients with no criteria or mechanism criteria at long distances from a trauma center may be initially evaluated at the closest hospital and transferred to a trauma center if hospitalization or ICU care is necessary. Further study to determine the predictive value of certain individual mechanism criteria is warranted.
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Outcome after cardiac arrest is strongly related to whether the patient has ventricular fibrillation at the time the emergency medical service (EMS) arrives on the scene. The occurrence of various arrhythmias at the time of EMS arrival among patients with out-of-hospital cardiac arrest was studied in relation to the interval from collapse and whether cardiopulmonary resuscitation (CPR) was initiated by a bystander. The patients studied were all those with out-of-hospital cardiac arrest in Goteborg, Sweden, between 1980 and 1992 in whom CPR was attempted by the arriving EMS and for whom the interval between collapse and the arrival of EMS was known. ⋯ There was a successive decline in occurrence of such arrhythmias with time. However, when the interval exceeded 20 minutes, ventricular fibrillation/tachycardia was still observed in 27% of cases. Bystander CPR increased the occurrence of such arrhythmias regardless of the interval between collapse and EMS arrival.