J Emerg Med
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Blunt injuries to the heart are common and potentially lethal. These injuries often go undetected while more obvious problems are treated. ⋯ The spectrum of cardiac trauma ranges from injuries with no actual cellular damage (myocardial concussion) to cardiac chamber rupture. The pathophysiology, diagnosis, and treatment of these injuries are discussed.
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Leukemic patients with extremely high white blood counts may exhibit the phenomenon of leukocyte larceny, in which white blood cells metabolize plasma oxygen in arterial blood gas samples (ABG) producing a spuriously low oxygen tension. We report the case of a leukemic patient with a white blood count in excess of 500,000 in whom multiple ABGs documented hypoxemia out of proportion to his clinical picture. Pulse oximetry was used to confirm higher hemoglobin oxygen saturation to establish the leukocyte larceny.
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Anterior shoulder dislocations are a common occurrence in busy emergency departments. Numerous techniques for treating this problem have been reported. ⋯ We report a simple, relatively painless, and atraumatic method of shoulder reduction involving manipulation of the scapula as well as the humerus. This technique has been used in our emergency department with considerable success and no complications.
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This is the fifth article in a continuing series on objectives to direct the training of emergency medicine residents. The emergency physician frequently must deal with hand injuries. Often these may appear innocuous; recognition of these injuries requires certain technical skills and a working knowledge of these entities. Specific objectives presented provide guidance for the didactic content as well as skill mastery for the resident experience.
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Physicians have a responsibility to society, their peers, and patients to participate in malpractice litigation in a manner that ensures that medical malpractice cases are properly evaluated. Physicians are reluctant to involve themselves as expert witnesses in medical malpractice litigation because of not wanting to further any malpractice suits, mistrust of attorneys and misconceptions about expert witnesses and the legal system in general. The expert witness should be an impartial practicing physician who can select those suits that should or should not be filed and identify which parties were negligent in each case. If impartial physicians do not evaluate cases for attorneys, other more partisan and less objective physicians will.