J Emerg Med
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All emergency departments face the possibility of having insufficient personnel to provide adequate care for patients. Such occasions may present an emergency department with several severely injured patients or merely an unusually large number of that emergency department's usual patient profile. ⋯ In addition, emergency department directors have an obligation to consider their particular staffing and usage patterns in order to try to devise the most efficient back-up policy prior to need. Finally, assessment of the success with which such back-up policies are used is discussed.
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To assess the moon's perceived impact on emergency medicine, a survey was conducted using a modified Belief in Lunar Effects (BILE) scale. Eighty percent of the respondent emergency department nurses and 64% of the emergency physicians believe that the moon affects patients. Of these nurses, 92% find lunar shifts more stressful and indicated lunar pay differentials are warranted. Medical, social, and administrative strategies to deal with lunacy are presented.
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Severe, acute cyanide poisoning is uncommon and can be very difficult to diagnose if a history of exposure is unavailable. Victims of smoke inhalation may have significant cyanide poisoning as well as carbon monoxide toxicity. The Lilly Cyanide Antidote Kit currently available in America unfortunately has its own inherent toxicity. ⋯ Case reports of human cyanide poisoning treated with hydroxycobalamin/sodium thiosulfate have been published only in French. Animal and human data on the use of this antidotal combination are reviewed. Hydroxycobalamin/sodium thiosulfate is an efficacious cyanide antidote with little inherent toxicity.
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Comparative Study Clinical Trial
Performance of disposable needle syringe systems for local anesthesia.
The performance of different disposable needle syringe systems was determined by measuring needle-puncture pain, needle-bending forces, and the fluid dynamics of the systems. Thirty-gauge needles cause less needle-puncture pain than any other needle. The force required to bend the 30-gauge needle irreversibly was lower than that for the other needles. ⋯ On the basis of the results of this study, 30-gauge needles attached to 10-mL syringes are recommended for infiltration anesthesia, and 25-gauge needles with 10-mL syringes are advocated for regional nerve blocks. In infiltration anesthesia, the local anesthetic agent should be injected slowly into the subdermal tissue over a 10-second period. When performing regional nerve blocks, it is also advisable to inject the local anesthetic agent over a 10-second time interval.