J Emerg Med
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Despite the Geneva Protocol of 1925 and the Paris Conference on Prohibition of Chemical Weapons in 1989, sulfur mustard and other chemical weapons continue to pose a hazard to both civilians and soldiers. The presence of artillery shells containing sulfur mustard, both in waters where these shells were dumped and in old battlefields, presents a problem in times of peace, especially for those who collect wartime memorabilia. Past literature has reported several hundred incidents involving fishermen who inadvertently pulled leaking shells aboard their fishing vessels, thereby exposing themselves to the vesicant chemical. ⋯ The purpose of this article is to report the first case of a serious sulfur mustard burn that occurred after removing the detonator from an old artillery shell in a historic battle field near Verdun, France. The circumstances surrounding the injury, the diagnosis and management of injuries secondary to sulfur mustard, and the long-term consequences to the patient are presented and discussed. Although skin grafting has been used in the management of other chemical burn injuries, this report is the first to describe the need for split-thickness skin grafts in the management of a patient with sulfur mustard burns.
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The purpose of this study is an analysis of 630 field intubations of trauma patients by flight personnel of the San Diego Life Flight program. We compared nasotracheal intubation to rapid sequence induction orotracheal intubation and noninduced orotracheal intubation. ⋯ The results of our study show that rapid sequence induction orotracheal intubation has a higher success rate, fewer complications, and a better patient outcome compared to noninduced orotracheal intubation and blind nasotracheal intubation. We recommend that rapid sequence induction oral intubation be the standard method for prehospital airway management in trauma patients.
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A retrospective chart review was conducted to define the demographic and injury patterns of patients presenting to the emergency department (ED). The setting is a rural/small urban tertiary care center with approximately 40,000 visits per year. All patients presenting to the ED from January 1986 through December 1990 with equestrian-related injuries were enrolled in the study. ⋯ There were no deaths. In conclusion, equestrian activities are associated with a risk of serious injury to both riders and handlers of horses. Education of both the public and primary care physicians should focus on injury prevention.
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Internal medicine is an essential but diverse field. This is the third in a three-part set of objectives for an off-service rotation in general internal medicine for emergency medicine residents. This series may be used to guide the resident during the rotation or to serve as part of a teaching program integrated with didactic training and emergency department experience.
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The term undifferentiated physician is applied to those physicians who have not received or are not receiving formal postgraduate training in emergency medicine. Many community and university hospitals offer an "emergency medicine" experience to this group of physicians, but most do not follow a defined curriculum. This set of educational objectives was developed under the auspices of the Canadian Association of Emergency Physicians (CAEP). ⋯ The objectives are intended for the undifferentiated physician whose practice will include emergency department (ED) work. The objectives are based on a 2-month rotation in the ED under the supervision of an attending physician who has either College of Family Physicians of Canada or Royal College of Physicians and Surgeons of Canada certification in emergency medicine. The purpose of these objectives is to provide guidelines for a uniform framework for the basic emergency medicine education of these undifferentiated physicians.