European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Review Practice Guideline Guideline
Guidelines for the management of severe head injury. Brain Trauma Foundation.
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Jugular bulb oximetry provides the first bedside available information on cerebral oxygen utilization. An extensive analysis was made of all initial jugular bulb oximetry data obtained in 150 patients within the first 12 h after severe traumatic brain injury. ⋯ Jugular bulb desaturation was especially related to systemic causes (such as a lowered cerebral perfusion pressure observed in 29 patients, and a lowered arterial carbon dioxide tension in 24 patients). These findings could have important implications for the emergency management of severely head-injured patients, as outcome might possibly be improved by better attention to all systemic factors that might reduce cerebral perfusion in the early hours after traumatic insult.
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Eighteen patients with small intestine or mesenteric injury following blunt abdominal trauma were operated over a 34-month period. Early diagnosis and surgery, less than 6 hours after admission, was achieved in 10 patients (56%), seven of whom had haemorrhagic shock and had positive diagnostic peritoneal lavage or ultrasonography on admission. Three haemodynamically stable patients had a diagnostic abdominal computed tomography. ⋯ Delayed diagnosis is often related to isolation of intestinal and mesenteric injury and results in increased morbidity and hospital stay. Every attempt should be made to reach a diagnosis within six hours of admission to the trauma unit. A management algorithm is proposed.
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We present a case of benign paradoxical vocal cord adduction' presenting to the emergency department as acute stridor. This patient received direct laryngoscopy at initial presentation documenting inspiratory vocal cord adduction. ⋯ Successful treatment has included relaxation, sedatives and speech therapy to abort the acute attack and prevent further recurrence. As direct flexible laryngoscopy is more readily available in the emergency department, goals for the future are more rapid diagnosis and appropriate treatment of this benign syndrome.