The American journal of emergency medicine
-
Comparative Study
Subungual hematoma: association with occult laceration requiring repair.
Subungual hematomas are one of the most common injuries involving the hand. On conducting a literature search, we were unable to find any studies that investigated the association between subungual hematomas, fractures, and the presence of an occult laceration of the nail bed requiring repair. Forty-seven consecutive patients who presented to the emergency department with subungual hematoma involving more than one fourth of the nail bed were included in this study. ⋯ In the subgroup of patients who had subungual hematoma associated with a fracture, all of them had a laceration requiring repair. Patients with a subungual hematoma greater than one half of the size of the nail bed had a 60% incidence of a laceration requiring repair. The authors believe that patients presenting with a subungual hematoma involving greater than one half of the nail surface and a fracture of the distal phalanx should have the nail lifted and the nail bed explored and repaired.
-
Comparative Study
Comparison of mechanical techniques of cardiopulmonary resuscitation: survival and neurologic outcome in dogs.
Three currently available mechanical devices for cardiopulmonary resuscitation (CPR) were compared using a canine cardiac arrest model. Twenty-four-hour survival without neurologic deficit was the goal. A group of 30 large mongrel dogs was divided equally among Thumper CPR, simultaneous compression and ventilation (SCV) CPR, and vest CPR. ⋯ However, coronary perfusion pressure was not different among the three mechanical methods. No differences in immediate resuscitation, 24-hour survival, or neurologic deficit scores at 24 hours were found. Neither SCV nor the vest techniques of CPR appear better for survival or neurologic outcome than standard cardiopulmonary resuscitation performed with the Thumper.
-
Headache is an early symptom of carbon monoxide (CO) poisoning, occurring at carboxyhemoglobin (COHb) levels of greater than 10%. We investigated 37 patients presenting to an emergency department during the winter-heating season with a complaint of headache for evidence of CO exposure. Seven of the 37 patients (18.9%) had COHb levels in excess of 10%, with a mean of 14.0%. ⋯ In six of the seven patients with elevated COHb levels (85.7%), gas company investigation or historical information obtained retrospectively revealed a definite or probably toxic CO exposure. In none of these patients had the diagnosis of CO poisoning been suspected by the emergency department physician or the patient prior to obtaining the result of the COHb level. Occult CO poisoning may be an important cause of winter headache.
-
There is considerable variation in emergency department practices concerning the use of intravenous (IV) rehydration. Sixty-eight patients seen in a pediatric emergency room and requiring IV rehydration were studied prospectively. Fifty-eight patients were rehydrated in the emergency room, and 10 were admitted for rehydration. ⋯ To determine outpatient IV rehydration practices, 214 pediatric training programs were surveyed. Of 173 respondents, 77 (44.5%) carry out IV rehydration in the emergency department in less than 5% of cases, and 115 (66.4%) perform it in less than 10% of cases; only 11.7% of programs carry out IV rehydration in the emergency department in most cases requiring such therapy. It is concluded that from the standpoints of cost effectiveness and patient acceptance, outpatient IV rehydration should be considered more often as a treatment option.