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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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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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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Delirium and dementia frequently pose a diagnostic dilemma for clinicians in the emergency department. The overlap of symptoms between organic brain syndrome and functional psychiatric illness, coupled with a dramatic presentation, often leads to a premature psychiatric diagnosis. In this paper, the authors discuss those symptoms of organic brain syndrome that most frequently generate diagnostic confusion in the emergency department and result in a misdiagnosis of functional illness.
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Codeine often causes gastrointestinal cramping and pain. Treatment for such symptoms is usually symptomatic and supportive. ⋯ The authors present four cases in which naloxone (Narcan) was used with success in relieving gastrointestinal side effects that were apparently due to codeine. It is suggested that patients with gastrointestinal symptoms and a history that strongly implicates codeine as the etiology be treated with naloxone.