The American journal of emergency medicine
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To evaluate the early variations of superoxide production of neutrophils (SPN) in injured patients, SPN was serially measured on the first, third, and seventh day after severe injury (injury severity score of >16). For patients receiving subsequent surgery, SPN was measured again on the first postoperative day. Eighteen patients were studied. ⋯ Patients with EMOD also had a higher injury severity score. In conclusion, subsequent surgery after injury has no effect on the priming of neutrophils. While late priming of neutrophils in injured patients coincides with the development of sepsis, suppression of SPN is found in septic patients with EMOD that frequently results from severe injury.
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A rare case is presented of intercondylar dislocation of the patella with vertical axis rotation. The injury was the result of blunt trauma directed to the lateral border of the patella. The patient presented with the knee locked in full extension and with a vertical ridge-shaped deformity caused by the medial border of the patella facing anteriorly. Reduction was accomplished under intravenous conscious sedation by manipulation.
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Disposal of sharp instruments and needles ("sharps") is an ongoing problem in the emergency department (ED). Cleanup and disposal of needles and other sharps after a procedure is the responsibility of all ED personnel, including physicians. ⋯ All techniques are designed to be done (1) without exposing physician to a needle stick, (2) with equipment readily available in the ED, and (3) with containers readily seen by those disposing of the sharps and other materials. Adherence to these cleanup procedures should help lessen the problem of sharps and disease exposure in the ED.
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Clinical Trial Controlled Clinical Trial
Provision for clinic patients in the ED produces more nonemergency visits.
This study sought to evaluate how the addition of a general practitioner (GP) surgery influences the utilization of an emergency department (ED). An intervention trial with historical control was conducted in a Swedish university hospital ED. A GP surgery was established in the ED by the addition of GP physicians without the addition of other personnel (nurses, secretaries, aids). ⋯ The percentage of patients managed in the ED who had nonurgent complaints (primary health care needs) increased with the intervention from 22% (95% confidence interval [CI] 19%, 25%) to 33% (95% CI 30%, 37%). The increased demand on the ED of patients with nonurgent complaints increased the average waiting time for patients with urgent or emergent complaints from 35 minutes to 40 minutes (14%). The introduction of GPs to an ED increased the number and proportion of patients presenting to the ED with nonurgent complaints.
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The pulse oximeter has become an essential tool in the modern practice of emergency medicine. However, despite the reliance placed on the information this monitor offers, the underlying principles and associated limitations of pulse oximetry are poorly understood by medical practitioners. ⋯ The accuracy of pulse oximetry is discussed in light of these factors, with further discussion of applications for pulse oximetry in emergency medicine, including both oximetric and plethysmographic operation. The pulse oximeter is an invaluable instrument for emergency medicine practice, but as with any test the data it offers must be critically appraised for proper interpretation and utilization.