The American journal of emergency medicine
-
The case records of 39 patients with classic (non-exertional) heatstroke presenting to an urban emergency department were reviewed. Eight of 39 patients died. ⋯ The rate of mortality in the rapid cooling group was four of 27 (15%), while in the delayed cooling group, the mortality rate was four of 12 (33%) (P = 0.18). Factors such as advanced age, hypotension, altered coagulation status, and the necessity for endotracheal intubation on presentation dictated a poor outcome despite successful cooling measures.
-
Randomized Controlled Trial Clinical Trial
Topical anesthesia for laceration repair: tetracaine versus TAC (tetracaine, adrenaline, and cocaine).
Topical anesthetics have always had a place in anesthetizing mucous membranes. The earliest writing in Greek medical literature makes reference to the use of these topical anesthetizing agents. Previous studies utilized a mixture of tetracaine, Adrenaline, and cocaine in the pediatric population with increased patient compliance. ⋯ The results indicate that the most efficacious use of TAC is on facial lacerations, regardless of length or depth. Of the 46 participants available for follow-up, one patient in the tetracaine group reported a wound infection. A recommendation of increased use of TAC on facial lacerations, in both the adult and pediatric populations, is made based on the results of this study.
-
Prompt identification of cardiac arrest by emergency dispatchers can save valuable time and increase the likelihood of successful resuscitation. The authors reviewed 516 cardiac and 146 non-cardiac calls to identify features of a probable cardiac arrest call. ⋯ When the patient is over 50 years old and the caller is emotional, the possibility of cardiac arrest is high, suggesting that questions about consciousness and breathing should be asked immediately. Additional information can be obtained or telephone cardiopulmonary resuscitation (CPR) instructions can be given after dispatch of an emergency vehicle.
-
Computer-aided teaching in the emergency department offers an important adjunct to traditional lectures and bedside clinical teaching. Using an integrated software system, lessons and patient simulations were created for the emergency department. ⋯ Acceptance and usage rates are high and remain so even after the initial novelty of the system declined. To be useful, such a system should be accessible over extended hours, and lessons should be brief and simple to execute.
-
A 64-year-old man presented to an emergency department with a two-week history of intermittent, bilateral lower extremity paralysis without associated chest, abdominal, or back pain. He subsequently deteriorated and died as a result of a thoracic aortic dissection. This unusual case is reported, and the pathophysiology, diagnosis, and management of aortic dissection are discussed.