The American journal of emergency medicine
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Three cases representing the emergency department use of pulse oximetry are described. A brief review of the principles of operation of pulse oximetry, as well as a discussion of recent literature and clinical uses of the technology, is presented. While not replacing arterial blood gases in the assessment of critically ill patients, a more widespread use of pulse oximetry in evaluating emergency department patients might provide significant information in the management of patients with respiratory complaints. Pulse oximetry may also play an important role in monitoring those patients requiring airway interventions such as assisted ventilation or endotracheal intubation.
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A patient with chronic renal failure presenting to the emergency department with acute pulmonary edema has a true life-threatening emergency. Whereas conventional treatment modalities may prove useful, more unusual therapeutic measures may be necessary. A case is presented followed by useful recommendations for the emergency physician faced with such a patient.
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Comparative Study Clinical Trial Controlled Clinical Trial
The knee-chest position does not improve the efficacy of ipecac-induced emesis.
Previous studies have shown that ipecac-induced emesis, even if instituted very early, removes only a mean of 28% to 45% of an ingested tracer. Because vomiting is an ancient reflex that occurs in mammals, reptiles, and other animals, we speculated that, in humans, maintaining a sitting rather than a horizontal posture during induced emesis might decrease the efficacy of gastric emptying. To test this hypothesis, 20 normal fasting adult subjects underwent induced emesis in the knee-chest position on one day and in the sitting position on another. ⋯ This represented 47.1% of the administered tracer dose (95% Cl, 40.1% to 54.0%). Even if initiated only ten minutes after an ingestion, ipecac-induced emesis removes an average of less than half of an ingested tracer dose, with a high degree of intersubject variability. Horizontal patient positioning does not appear to improve the efficacy of this procedure.