J Emerg Med
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Superficial abscesses are commonly seen in the emergency department. In most cases, they can be adequately treated by the emergency physician without hospital admission. Treatment consists of surgical drainage with the addition of antibiotics in selected cases. ⋯ Staphylococcus aureus accounts for less than half of all cutaneous abscesses. Anaerobic bacteria are common etiologic agents in the perineum and account for the majority of all cutaneous abscesses. Abscesses at specific locations involve special consideration for diagnosis and treatment and may require specialty consultation.
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There is growing concern in academic emergency medicine as to the appropriateness of 24-hour faculty coverage in the teaching emergency department. We surveyed 170 teaching emergency departments, 49 of which had approved emergency medicine residencies, asking for information regarding 24-hour faculty coverage. We were able to separate each department into one of 15 profiles based on the two variables of average ED yearly census and hospital type. Seventy-three percent of university teaching hospital EDs and 65% of those with emergency medicine residencies have 24-hour faculty coverage; 83% of private teaching hospital EDs and 100% of those with emergency medicine residencies have 24-hour faculty coverage; and 79% of city/county teaching hospital EDs and 80% of those with emergency medicine residencies have 24-hour faculty coverage.
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Case Reports
Fatal intracranial hemorrhage associated with phenylpropanolamine, pentazocine, and tripelennamine overdose.
Hemorrhagic cerebrovascular accident is an uncommon but serious complication of drug overdose. A case of fatal intracranial hemorrhage following overdose with phenylpropanolamine, pentazocine, and tripelennamine is presented. The pharmacology, pathophysiology, clinical presentation, and management of poisoning by these agents are discussed.
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Since Henry Heimlich's description of a method for relieving food choking was presented, the management of foreign body upper airway obstruction has been enveloped in controversy. The major point of contention has been the approval by the American Red Cross and American Heart Association of the chest thrust and back blows, techniques that Heimlich considered inferior and dangerous. ⋯ Most studies have found airway pressures generated by back blows to be higher than those produced by chest or abdominal thrusts. However, chest and abdominal thrusts produce their effects over a more sustained time period.
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Percutaneous central venous catheterization provides access for volume replacement and hemodynamic monitoring. This study reviewed 119 percutaneous central venous catheterizations in 112 patients over a 12-month period. All catheters were placed by emergency department (ED) physicians or housestaff under their direct guidance. ⋯ Postoperatively, five (26%) of these were converted to pulmonary artery catheters. Central venous catheters can be placed in patients percutaneously in the emergency department with minimal morbidity. They provide initial access to the central circulation for resuscitation and subsequently can be converted to pulmonary artery catheters for hemodynamic monitoring.