The American journal of emergency medicine
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Mechanical ventilation is frequently initiated by emergency physicians. Further, the physician on duty in the emergency department is frequently responsible for evaluating ventilated patients who decompensate in the intensive care unit when other physicians are not present in the hospital. ⋯ Knowledge of the pathophysiology of acute respiratory failure and changes in lung physiology during positive pressure ventilation will aid the emergency physician in choosing an appropriate ventilator modality and initial settings to maximally benefit patients with respiratory insufficiency due to various causes. An appreciation of the adverse effects of mechanical ventilation and problems commonly encountered in patients on ventilators will prepare the emergency physician to rapidly assess and effectively manage the patient who deteriorates in this setting.
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Review Case Reports
Boerhaave's syndrome presenting with abdominal pain and right hydropneumothorax.
This case of Boerhaave's Syndrome had several unusual features including a delayed presentation and right-sided esophageal perforation. The patient's initial episode of hematemesis may have been caused by a small mucosal laceration in the area of the Barrett's lesion that later ruptured. On the other hand, if initially there was an esophageal rupture, it did not violate the parietal pleura or mediastinum. ⋯ The single most important test may be the upright chest X-ray. However, if it is normal, and there is a high index of suspicion, esophagograms and or chest CT may be required to demonstrate the lesion. Because survival is directly related to the time to diagnosis and treatment, a high clinical suspicion can decrease the substantial morbidity and mortality associated with Boerhaave's Syndrome.
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Clinical Trial Controlled Clinical Trial
Are emergency departments really a "safety net" for the medically indigent?
This study was designed to quantify the willingness of emergency departments (EDs) and private care practitioners to see medically indigent patients. Three case scenarios were developed to represent severe, moderate, and mild problems that typically confront ED physicians. A female investigator made telephone calls using these scenarios, each time declaring herself to be medically indigent. ⋯ Private practitioners in the largest communities were significantly more reluctant to see the medically indigent than their peers in smaller communities (P < .05). For an insured caller, 55% of private practitioners would see the caller for < $30 and only 35% were not taking new patients or provided referral. In contrast to most private primary care practitioners, EDs are at least willing to serve as a triage point for the medically indigent and are often the primary-care "safety net" for the medically indigent.