The American journal of emergency medicine
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Review Case Reports
Methemoglobinemia secondary to automobile exhaust fumes.
Methemoglobinemia is an uncommon cause of cyanosis. A 28-year-old male presented to the emergency department cyanotic and short of breath after exposure to noxious automobile fumes. He did not improve with the administration of 100% oxygen therapy. ⋯ Methylene blue was given (2 mg/kg intravenously) and the patient's symptoms resolved. On the following day he was discharged home without complication. A comprehensive review of the literature revealed no reported cases of methemoglobinemia secondary to accidental exposure to exhaust fumes.
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A 21-year-old woman was brought to the emergency department after being found unconscious in a hotel lobby. On presentation, she was awake but confused. The initial evaluation revealed no evidence of trauma, metabolic abnormality, drug ingestion, or intracranial process. ⋯ After definitive electrophysiologic study, the diagnosis of long QT syndrome was made. Treatment consisting of beta blockade and pacemaker insertion prevented further arrythmia or seizure activity. Long QT syndrome should be considered a possible etiology in any patient presenting with new onset seizures, especially in the young.
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The authors conducted a prospective study to assess the performance of paramedics with prior adult endotracheal intubation experience in pediatric intubation in the operating room of a teaching hospital. Nineteen paramedic students were observed attempting endotracheal intubation on a total of 57 anesthetized pediatric patients undergoing scheduled surgical procedures. The average age of patients was 5.1 years (range, 6 months to 15.2 years). ⋯ Only minor complications occurred, and were limited to intubation attempts of greater than 45 seconds duration in four cases (6%), and patient oxygen saturation less than 90% in one case (2%). The study suggests that paramedics may be successfully incorporated into a hospital's clinical training program, and can receive closely supervised experience in pediatric endotracheal intubation without compromising patient care. Such training may increase the willingness of paramedics to attempt emergent prehospital endotracheal intubation of children, as well as increase their success with this potentially life-saving procedure.
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This study evaluated the nature and efficacy of compliance with emergency department (ED) patient referral recommendations. This was a prospective, nonrandomized, descriptive analysis of all ED patients referred mandatorily to an established urban hospital follow-up network. Compliance was measured by analysis of hospital records determined as appointment completion. ⋯ Patients encountered had higher rates of compliance if female (33.9%), greater than 40 years of age (43.4%), with urgent complaints (46.8%), and if referred to private physicians (37.0%) (P less than .001). Compliance also correlated with the diagnosis of fracture (63.3%) or laceration (45.6%); and specialty referral to obstetrics-gynecology (28.4%) and general surgery (22.4%) consultants (P less than .01). Most patients demonstrate low compliance (28%) with follow-up recommendations, even with a directed ED referral system.
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New methods of deciding which patients require trauma center transport continue to be devised. Baxt recently published a Trauma Triage Rule (TTR) using anatomic injury, blood pressure, and elements of the Glascow Coma scale which can be used to identify adult major trauma patients. The purpose of this study was to compare the TTR against three previously published trauma triage instruments; the Triage-Revised Trauma Score, the Prehospital Index, and the CRAMS scale. ⋯ All four instruments identified adult trauma patients who either died or required emergent operations with sensitivities of at least .85. The specificity of the TTR exceeded that of the CRAMS. We conclude that the TTR is an effective means of identifying patients who either die or require emergent operation.