J Emerg Med
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Case Reports
Emergency department echocardiography in the diagnosis and therapy of cardiac tamponade.
A 44-year-old male presented to the emergency department in shock with jugular venous distension and upper chest cyanosis. Superior vena cava syndrome was ruled out by computed tomography (CT scan). However, a large pericardial effusion was found on CT scan and confirmed by sonography. Pericardial tamponade was diagnosed by emergency physicians and sonography-guided pericardiocentesis was performed with marked improvement in symptomatology.
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Anticonvulsant management of status epilepticus (SE) may result in respiratory depression, often requiring endotracheal intubation (ETI). By examining rates of ETI in childhood SE after intravenous diazepam or lorazepam, when administered alone or in combination with phenytoin, the influence of anticonvulsants on the frequency of ETI during SE was determined. The medical records of 142 consecutive children younger than 16 years of age admitted from a university hospital ED with seizures during a 28-month period were retrospectively reviewed. ⋯ Patients receiving lorazepam had ETI rate of 27% (4/15), compared to 73% (8/11) in the diazepam group (P = 0.026, Fisher's exact). The groups were not significantly different in age, weight, sex, seizure type, seizure duration, and appropriate anticonvulsant dosage. A prospective, randomized trial comparing lorazepam and diazepam is warranted to confirm the apparent advantage of lorazepam in reducing respiratory depression.
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This is the sixth article in a continuing series on objectives for emergency medicine training; otolaryngological objectives will be presented. Otolaryngological skills and knowledge areas are frequently encountered in clinical practice. The Core Content in emergency medicine devotes an entire section to their listing. ⋯ Specific behaviorally based objectives for mastery of knowledge and skill areas provide guidance in a training rotation not directly under emergency medicine faculty supervision. References are suggested for additional and supportive information and reinforcement in skill and knowledge area mastery. These objectives are presented to aid in directing training of emergency medicine residents on an otolaryngological service.
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This is a continuing series of objectives to direct resident training in emergency medicine. Electrocardiography may not receive individual attention in many training programs. However, the importance, omnipresence, and medicolegal potential of electrocardiography in the practice of emergency medicine suggests its individual attention. Contents and specific learning objectives are presented to provide guidelines for resident mastery, following the format presented by preceding subjects.