The American journal of emergency medicine
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There is controversy regarding needle aspiration for primary spontaneous pneumothorax (PSP), with contradictory recommendations between the American College of Chest Physicians consensus statement (2001), which suggests that needle aspiration has little place in the management of PSP, and the British Thoracic Society guidelines (2010), which recommend that needle aspiration be attempted first for all cases of PSP where drainage is deemed necessary. Studies have shown that there is no significant difference between needle aspiration and tube thoracostomy with regard to safety, rates of immediate success, and early failure and has the advantages of decreasing pain and reducing rates of hospital admission and duration of hospital stay compared with tube thoracostomy. Point-of-care ultrasound (US) can facilitate needle aspiration by decreasing the risk of complications and detect pneumothorax resolution during or re-expansion after the procedure. ⋯ This technique allows the determination of pneumothorax resolution or re-expansion in real time. Point-of-care US may assist in the evaluation and management of spontaneous pneumothorax in the pediatric ED. Ultrasound-assisted needle aspiration may be a safe and less painful option for pediatric ED patients with PSP.
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Individuals who live and work in the Southeastern coastal range of the 3 US crocodilian carnivores, American alligators, American crocodiles, and caiman, understand the risks of reptile-human encounters. Individuals who live in other parts of the country maybe exposed through contact with exotic pets at private homes, small menageries, or petting zoos or from escaped or abandoned animals. ⋯ The emergency management of large crocodilian injuries is similar to that of other major trauma; however, providers also must take into consideration the significant crush component potentially inflicted by the tremendous bite power and shaking inflicting during attacks by these large reptiles, appropriate antibiotic coverage for less common organisms that inhabit their mouths, and management of possible psychological distress, including posttraumatic stress disorder produced by such an unusual attack. Emergency physicians should support the development of a readily available national database of scientifically collect information on attacks to inform appropriate care and support efforts to explore responsible measures that the USDA Animal and Plant Health Inspection Service and other appropriate local, state, and federal agencies can take to ensure ethical and biologically sustainable management of our large reptiles, which also helps to ensure the safety of the public.