The American journal of emergency medicine
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Dislocation of the mandible occurs commonly. Most patients present to the emergency department for treatment. This article discusses the normal temporomandibular joint (TMJ) anatomy and the etiology, types, and diagnosis of mandibular dislocation. It also describes the initial management, including techniques for reduction of the acute anteriorly dislocated mandible.
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A technique to enhance difficult percutaneous radial artery cannulations using Doppler ultrasound is described. A series of 12 patients (nine hypotensive and three normotensive patients with poorly palpable or absent radial pulses) was assembled and the radial arteries were cannulated using standard intravenous catheters and a hand-held Doppler ultrasound device. Localization and cannulation of the arteries was facilitated by noting the characteristic sounds using the Doppler. ⋯ In one case the artery was localized but the catheter could not be advanced. No complications were encountered. It was concluded that the use of a common Doppler ultrasound on selected patients with poor peripheral pulses may facilitate percutaneous radial artery cannulations and minimize the number of catheter punctures before successful placement.
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Case Reports
Bilateral hypothenar hammer syndrome: an unusual and preventable cause of digital ischemia.
Unilateral ischemia of hand digits is usually caused by thoracic outlet obstruction, arterial emboli from a cardiac source, or atherosclerosis. The case of a metal press worker with unilateral ischemia due to hypothenar hammer syndrome, a condition caused by the repetitive use of the hypothenar eminence as a hammer with resultant damage to the ulnar artery, is described. ⋯ This patient had used both hands repeatedly to pound the edges of large steel plates and presented with nondominant-hand ischemia, but was found to have the syndrome bilaterally by angiography. The distinctive features of this syndrome, a preventable and treatable cause of digital ischemia, are emphasized.
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To establish an incidence of cervical spine injuries in significant blunt head trauma and to evaluate the necessity of using cervical radiography, all consecutive cases of blunt head trauma admitted to the trauma service over a 7-month period were reviewed. Two hundred twenty-eight charts were reviewed for demographic information, circumstance of injury, complaints and physical findings referable to the cervical spine, presenting level of consciousness, severity of head injury, and cervical spine radiographic findings. ⋯ The patient population was defined, yet the very low incidence of cervical spine injuries associated with blunt head trauma in this study precludes any identification of predictors. Nevertheless, the results suggest that alert and asymptomatic patients can be spared cervical spine radiography.
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Status epilepticus is a neurologic emergency with an 8% to 12% mortality. Rapid ablation of seizure activity is imperative. Although intravenous administration of diazepam is the preferred immediate treatment, vascular access is often difficult to achieve. ⋯ Rectal diazepam appears to be safe and efficacious. It should be considered as an alternate to intravenous therapy when immediate vascular access is delayed. Rectal diazepam may have great benefit in the prehospital setting.