J Emerg Med
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Recently, the Committee of Accident and Poison Prevention of the American Academy of Pediatrics presented its recommendations regarding the emergency management of the choking child. Renewed interest was stimulated in the controversy regarding whether back blows, abdominal thrusts, or chest thrusts should be used in the initial treatment of foreign-body obstruction of the upper airway. Two cases exemplifying problems in patient management are presented as a basis of focusing on the current controversy. Review of the clinical and experimental data suggests that back blows, followed by either chest or abdominal thrusts, are a reasonable approach to emergency airway obstruction, but that this recommendation is based on limited evidence.
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The incidence of abnormalities in 1,869 sets of radiographs was recorded, and the accuracy of the interpretation of these films by emergency physicians was assessed. Abnormalities were most frequent in hip/femur (52.5%), thoracic spine (46.7%), and shoulder (44.8%) films and least frequent in skull (5.7%), cervical spine (14.9%), and foot (15.7%) films. The accuracy of interpretation by emergency physicians for all categories of films was 93.6%, with 1.8% false positives and 4.6% false negatives. ⋯ The incidence of missing existing pathology was highest for abdomen (40.0%) and knee (31.6%) films. The overall accuracy of the emergency physicians in interpretation of emergency films was excellent. Increased didactics in particular areas of interpretive inaccuracies should be considered.
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Accidental hypothermia is defined as an environmentally induced reduction of the core body temperature to 35 degrees C or below, where there is no primary endocrine or preoptic anterior hypothalmic dysfunction. We report a survivor of 12 episodes of accidental hypothermia. ⋯ Multiple predisposing factors contributed to the repeated episodes of hypothermia. Anatomic causes of repeated nonaccidental hypothermia were excluded.
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Case Reports
Free intraperitoneal cholelithiasis--a sign of traumatic perforation of the gallbladder.
Traumatic perforation of the gallbladder is relatively infrequent and is rare as an isolated lesion. The unique aspect of this case is the diagnosis of traumatic gallbladder perforation based on plain abdominal roentgenographic evidence of free intraperitoneal cholelithiasis.
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Comparative Study
A survey of prehospital care paramedic/physician communication for Multnomah County (Portland), Oregon.
All field paramedic/patient encounters requiring advanced life support management in Multnomah County, Oregon, required radio/telephone communications with the emergency department physicians of the county's single medical resource hospital for a period of 6 months. A survey of these communications (compliance estimated to be 75% to 80%) demonstrated that paramedics established contact during management or transport in one-half of instances and after transport in the remainder. Consultation was estimated to be helpful in 12% to 17% of cases and of critical importance rarely. Additional benefits were seen in hospital notification, education, and as an adjunct to the medical record; and the concept of a single centralized resource hospital was established in this community.