The American journal of emergency medicine
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The emergency department (ED) care of a patient with a tracheostomy tube can be problematic because of difficulty with patient communication, urgency of airway control, and unfamiliarity with tracheal equipment. The objective of this study was to characterize complications of tracheostomy patients seen in the ED and provide management techniques. A retrospective study was conducted on all patients with tracheostomy complications who presented to a university, tertiary-care ED over a 7-year period. ⋯ During the study period, 35 patients were evaluated in the ED for 60 complications. The 60 complications were categorized into six groups: 20 (33%) patients presented with dislodged tracheal tubes, 11 (18%) presented with plugged tracheal tubes, 18 (30%) had infection, 7 (11%) had bleeding, 1 (3%) had a pnuemothorax, and 3 (5%) had tracheal/stomal stenosis. Review of the complications that place tracheostomy patients at high risk in conjunction with a review of the literature enabled the development of a standard approach to dealing with patients with tracheostomies that can facilitate proper care of the patients in the ED.
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Dissection of the internal carotid artery is responsible for approximately 5% of ischemic strokes in adults. The pathophysiology of dissection can be either traumatic or spontaneous. The true incidence of spontaneous dissection is unknown. ⋯ It is well recognized by neurologists but often not by other physicians. Prognosis is good, but delay in diagnosis may result in residual neurologic deficits. It should therefore be suspected early, especially in younger patients presenting with transient ischemic attacks or stroke.
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Effectiveness of CPR performance on a manikin was evaluated immediately after training in public CPR classes by trained independent observers using validated measures and procedures. An instrumented manikin was used to assess critical skills thought to be related to survival following out-of-hospital cardiac arrest (compressions and ventilations), applying standards of the American Heart Association. The 226 subjects were enrolled in CPR classes offered to the public by the American Red Cross and the American Heart Association. ⋯ According to published criteria, trainee performance of CPR is poor. Failure in critical skills may contribute to poor survival rate following out-of-hospital cardiac arrest. CPR training programs must be developed with attention to learner outcomes.
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Studies on the effectiveness of pain management have uniformly concluded that health care providers underestimate or undertreat pain. In the emergency department (ED) in which this study was conducted, physicians receive formal didactic and bedside teaching on pain recognition and management in order to heighten the awareness of patients' need for pain control. The purpose of this study was to determine if this outpatient pain management of patients with acute, painful conditions is better than that reported in the medical literature. ⋯ Patient satisfaction with pain control was higher (91%) than that reported in the medical literature. Also, pain medication was provided more frequently by this study's ED (95%). Education on pain awareness and treatment is a way to improve pain management.
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Randomized Controlled Trial Comparative Study Clinical Trial
Salbutamol treatment of acute severe asthma in the ED: MDI versus hand-held nebulizer.
The objectives of this study were to compare the efficacy of salbutamol delivered by either metered-dose inhaler plus spacer (MDI-spacer) or by wet nebulization (NEB), and to determine the relationships between physiologic responses and plasma salbutamol concentrations. Asthmatic patients presenting to the emergency department (ED) with acute severe asthma (forced expiratory volume in the first second [FEV1] less than 50% of predicted) were enrolled in a randomized, double-blind, parallel-group study. The MDI-spacer group received salbutamol, delivered via MDI into a spacer device, in four puffs actuated in rapid succession at 10-minute intervals (2.4 mg/h). ⋯ Additionally, the NEB group presented a higher incidence of tremor (P=.03) and anxiety (P=.04), reflecting larger systemic absorption of salbutamol. These data indicate that when doses used are calculated on the basis of the percentage of total drug that reaches the lower airway, there was equivalent bronchodilatation after salbutamol administered by either MDI-spacer or nebulization in patients with acute severe asthma. However, nebulizer therapy produced greater side effects related to the increase in salbutamol absorption and higher plasma level.