The American journal of emergency medicine
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A 66-year-old man with a history of chronic alcoholism presented with Kussmaul respirations following several days of fasting accompanied by vomiting, in the presence of continued ethanol intake. He was subsequently found to have a serum glucose level of <20 mg/dL and an anion gap of 36. Despite his profound hypoglycemia, he was fully alert with no obvious neurological deficits. ⋯ He had no evidence of hypoxemia, hypotension, or other features of sepsis. Alcoholic ketoacidosis in the setting of hypoglycemia is discussed. If the serum glucose level is less than the anion gap, the diagnosis of alcoholic ketoacidosis should be considered.
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Review Multicenter Study
Rapid sequence intubation in adults with elevated intracranial pressure: a survey of emergency medicine residency programs.
A questionnaire entitled "Survey of Protocols for Rapid Sequence Intubation in Previously Healthy Adults with Elevated Intracranial Pressure" was distributed to the program directors of all 100 emergency medicine residency programs listed in the Directory of Graduate Medical Education Programs in February 1995. The medical literature on rapid sequence intubation in patients with suspected intracranial pressure elevations was reviewed. The findings of the review were compared with the survey responses. ⋯ Most of these programs follow the guidelines recommended in the medical literature. The majority of these guidelines, however, are based on statistical data performed in the laboratory or nonemergency environments. Further clinical studies in an emergency medicine environment must be performed to determine the optimal drug regimen for rapid sequence intubation in patients with elevated intracranial pressure.
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Multicenter Study
Photograph documentation of motor vehicle damage by EMTs at the scene: a prospective multicenter study in the United States.
The purpose of this study was to determine if emergency medical service (EMS) personnel could take instant photographs of motor vehicle damage at crash scenes depicting the area and severity of damage of the crash under adverse weather conditions, in different lighting, and quickly enough so as not to interfere with patient care. This prospective multicenter trial involved 35 ambulances responding to motor vehicle crash scenes in rural, suburban, and urban areas in five centers in four states. Emergency medical technicians (EMTs) reported their experience implementing a protocol for use of an instant camera to photograph vehicle damage at crash scenes. ⋯ From one EMS agency in the study, 48 scene times during which photographs were taken were, on average, 1.5 minutes shorter than 48 scene times immediately before implementation of on-scene crash photography. Photographs were taken in different weather and lighting conditions. EMTs reported they were able to determine both area and severity of damage in 260 of 290 (92.5%) crash photographs, but they were unable to determine area and severity of damage in only 2 of 290 (0.7%) crash photographs.
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Multicenter Study
Use of physician extenders and fast tracks in United States emergency departments.
To describe current practice regarding the use of physician extenders (PEs) and the "fast track" (FT) concept in United States emergency departments (EDs), a telephone survey of 250 US health care facilities offering emergency services was conducted. Of the EDs surveyed, 21.6% were using PEs at the time of the survey, and of those not using PEs, 23.5% intended to do so within the next 2 years. Those using PEs had been using them for a mean duration of 3.5 years (the mode was 2 years). ⋯ The mean estimated percentage of ED patients going through FT was 30.1%. The mean number of hours per day of FT operation was 13.4 hours on weekdays and 13.7 hours on weekends (the mode was 12 hours/day both on weekdays and weekends). Of hospitals using PEs in the ED, 56.0% had FT; of hospitals without PEs in the ED, 23.5% had FT.
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Acute traumatic aortic injury (ATAI) results in several characteristic chest radiographic findings, most notably mediastinal widening. This study was based on the hypothesis that blood or fluid in the widened mediastinum might track up into the neck and be detected on lateral cervical radiographs. In a blinded, retrospective, case-control review of radiology files, 13 consecutive adult cases of ATAI were identified and compared with 19 cases of negative aortography (NAO) and 18 multiple trauma victims (MT) without aortography. ⋯ Cervical ST measurements at C3 or at C6 did not correlate with mediastinal-chest width ratios. Mediastinal widening, aortopulmonic window opacification, and blurring of the aortic knob were the most sensitive chest radiography findings in ATAI, although each of these lacked useful specificity and accuracy. Cervical ST swelling is not a useful marker for ATAI.