J Emerg Med
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The use of thrombolytic agents for both coronary and noncoronary indications is a rapidly progressing field. There has been substantial debate over which disease processes ultimately benefit from the use of thrombolytic agents. In addition, many recent studies have focused on comparing different thrombolytic agents and dosing regimens in an attempt to gain optimal therapeutic benefit with minimal risk. This paper discusses the current status of thrombolytic therapy for coronary artery disease, pulmonary embolus, peripheral vascular thrombosis, and cerebrovascular infarction.
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Reports of occupationally transmitted hepatitis B virus (HBV) and human immunodeficiency virus (HIV) prompted the Portland Bureau of Fire Rescue and Emergency Services (PFB) to institute a comprehensive program for handling and tracking on-the-job infectious disease exposures. Data were collected for a 2-year period beginning January 1, 1988, and ending December 31, 1989, utilizing verbal and written exposure reports, prehospital care reports, and PFB statistical information. Two hundred and fifty-six (256) exposures were categorized. ⋯ Of this group, 11 individuals (26%) previously vaccinated against hepatitis B demonstrated inadequate HBsAb titers at the time of exposure. Requests for HIV and HBV information on source patients were made for needle sticks or exposure of nonintact skin or mucous membranes to blood or high-risk body fluids. Information on the source patient's HIV status was obtained for 57% of these requests.(ABSTRACT TRUNCATED AT 250 WORDS)
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Radiographic evaluation of the cervical spine begins with anteroposterior, lateral, and odontoid views. Unless the junction of C7-T1 can be adequately visualized on the cross-table lateral view, a swimmer's view is often performed. ⋯ The present case study describes a trauma patient suffering from neck pain in whom cervical spine instability was ruled out using a swimmer's flexion-extension technique. Further study of this technique as a supplement to the conventional flexion and extension views in the stressed assessment of the entire cervical spine is recommended.
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Limited information exists in the current medical literature regarding the performance of surgical cricothyrotomy by flight nurse personnel. We undertook a retrospective review of all flight records from our regional air ambulance service. The flight team transported 2,188 patients during this time; 69 patients required surgical cricothyrotomy for airway access. ⋯ A secure airway was established in 98.5% of the cases (68/69). Acute complications involved hemorrhage (3) and placement (3) with a complication rate of 8.7%. We conclude that surgical cricothyrotomy can be performed by well-trained flight nurses with a high success rate and an acceptable complication rate.
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This article outlines the objectives for a resident rotation in an in-patient pediatric service. The objectives can be successfully implemented in a 2-month sequential exposure to an in-patient ward service followed by an intensive care unit rotation in the first year of postgraduate training. These objectives are a part of a continuing series in the goals and objectives to direct emergency medicine resident training on off-service rotations.