The American journal of emergency medicine
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Bag-valve-mask (BVM) and oxygen-powered demand valve (OPDV) are two available adjuncts for artificial ventilation. Use of OPVDs has been limited by concern for causing or worsening pneumothorax. This study examined the effect of OPDV and BVM ventilation in swine with pneumothorax. ⋯ However, multiple comparisons showed no significant differences between OPDV and BVM at any time points. In this model, OPDV and BVM ventilation did not differ in their effects on pneumothorax volume or hemodynamic variables. No animal showed signs of tension pneumothorax.
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Activation of the emergency medical services (EMS) system does not always result in transport of a patient to the hospital. This study assessed the outcomes of patients who refused medical assistance in the field, to determine if refusal of medical assistance (RMA) is associated with poor outcomes. Four high-volume suburban volunteer ambulance corps participated in the study. ⋯ Even if none of the patients lost to follow-up had sought further care, a substantial number of patients who refuse out-of-hospital medical assistance seek further care. Some of these patients require hospital admission, especially those with cardiac or respiratory complaints. Efforts to minimize RMA should be especially focused on patients with such complaints.
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Comment Letter Case Reports
Gas gangrene secondary to subcutaneous insulin injection.
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The purpose of this study was to evaluate the effects of mannitol (Man), dexamethasone (DM), dichloroacetic acid (DCA) and 1,3-butanediol (BD) in reduction of posttraumatic cortical edema following brain deformation injury to rats. Ten minutes prior to fluid percussion injury, each animal received one of four pretreatments or placebo: Man, 1 g/kg intravenously, DM 3.0 mg/kg intravenously, DCA 25 mg/kg intraperitoneally BD 0.5 mg/kg intraperitoneally (n = 12 per treatment group), or equivolume saline (n = 8 per corresponding trauma group). Six hours after trauma, cortical tissue was harvested. ⋯ The measured cortical SpG from traumatized animals receiving Man (mean 1.037 +/- SEM .001), DCA (1.038 +/- .001), and BD (1.039 +/- .001) were equal to SpG from untraumitized cortex (1.041 +/- .001), and were significantly greater than SpG from traumatized cortex for animals receiving DM (1.035 +/- .001) or placebo (1.033 +/- .002). Pretreatment with DCA, Man, and BD appears to protect against development of posttraumatic cortical edema when measured 6 hours after blunt head trauma in the rat. Each of these chemical treatments appears effective in preventing or reducing posttraumatic cortical edema.
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The nose is perhaps the most common site for the insertion of foreign bodies by children. Removal is essential. ⋯ Conscious sedation was not required. There were no complications.