The American journal of emergency medicine
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The purpose of this study was to use a meta-analysis of the current literature to identify which patients with blunt cardiac trauma develop complications. All studies on myocardial contusion since 1967 were reviewed. Three separate meta-analyses were performed: one with only prospective studies, one with only retrospective studies, and one with all studies combined. ⋯ The data support the use of ECG and CPK-MB in the diagnosis of clinically significant myocardial contusion. Radionuclide scanning is not useful in the evaluation of patients with blunt cardiac trauma. Further studies need to define the role of echocardiography.
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Although survival with traumatic atlanto-occipital dislocation (AOD) is rare, there have been reports of victims who have sustained this injury with good neurological outcome. Plain lateral cervical spine radiography is the initial diagnostic procedure but may miss subtle dislocations. Several methods for the interpretation of the normal atlanto-occipital alignment have been devised and are discussed. ⋯ Halo immobilization and posterior spinal fusion are the preferred modes of treatment. Vascular injury may contribute to the neurological deficits seen with AOD and is potentially reversible. Three cases are reported, two with survival of 1 day, and one long-term survivor with poor neurological outcome because of associated cerebral trauma.
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In an attempt to provide comprehensive and timely patient care, emergency physicians have begun to use ultrasonography to perform and interpret goal-oriented examinations. Reducing time to diagnosis can potentially have a major impact on the treatment of patients with ruptured ectopic pregnancy, leaking aortic aneurysm, and cardiac tamponade, who require time-sensitive surgical intervention. A review of three cases reveals how ultrasonography performed by emergency physicians can rapidly provide valuable diagnostic information and expedite patient care in three different clinical scenarios.
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Modern health care reform emphasizes efficient resource and facility management and the need to develop strategies to direct patients with lower-acuity concerns away from the relatively cost-inefficient full-service pediatric emergency department (ED). This study examined a pediatric fast track system for triage accuracy and turnaround times. Egleston Children's Hospital is a regional, urban, tertiary-care academic center which is a major teaching affiliate of Emory University School of Medicine. ⋯ Only 63 of the 2,243 (2.8%) patients assigned to fast track were found to have higher acuity levels than suspected at initial triage. In all cases they were appropriately cared for in the fast track area. The fast track system appears to be an effective method by which an urban pediatric ED can efficiently maintain patient flow in light of limited resources, space constraints, limited manpower, and an increasing census.