The American journal of emergency medicine
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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.
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This study was conducted to evaluate the blood urea nitrogen/creatinine (BUN/Cr) ratio for distinguishing an upper versus lower source of gastrointestinal (GI) bleeding. Charts of patients who presented to the emergency department (ED) with the diagnosis of GI bleeding from August 1995 to August 1996 were retrospectively reviewed for source of bleeding, initial BUN, Cr, BUN/Cr ratio, hematocrit (Hct), and need for transfusion. A total of 124 patients were eligible for inclusion, 71 (57%) of whom were male. ⋯ Upper GI bleeding was significantly correlated with age younger than 50 (P = .01) and male gender (P = .01; odds ratio, 3.13). Taking into account age and gender, the BUN/Cr ratio correlated significantly with an upper GI source of bleeding (P = .03), with a ratio greater than 36 having a sensitivity of 90% and a specificity of 27%. The area under the receiver operating characteristic curve using age, gender, and BUN/Cr ratio was .73 (95% confidence interval, .62 to .84).
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Sedation with analgesia is frequently required to perform painful or invasive procedures in children. The best medication combination for pediatric sedation with analgesia is yet to be identified. Sixty-four of 243 total sedation with analgesia procedures from January 1994 through August 1995 were randomly chosen for descriptive retrospective review and analysis. ⋯ No episodes of respiratory depression, hypotension, or nausea and vomiting occurred in the fentanyl/propofol group. These results show that fentanyl/propofol was superior to other medications used during this study period for pediatric sedation with analgesia. Prospective comparison of this medication combination with other short-acting agents in patients undergoing both elective and emergency procedures is necessary.
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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.