J Emerg Med
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The continuous measurement of arterial oxygen saturation using pulse oximetry (SpO2) has become popular for critically ill hospitalized patients. Its use in the ambulance transfer of similarly ill patients has been infrequently documented. This study examines the use of prehospital pulse oximetry, with special reference to the ability of ambulance attendants to recognize hypoxemia. ⋯ Hypoxemia, defined as SpO2 of less than 90% for more than 1 minute, was detected in 14 patients. Attendants recognized hypoxemia on clinical grounds in only 4 patients (sensitivity = 28%). Forty-one (82%) patients received various amounts of supplemental oxygen; many patients remained hypoxemic despite therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Review Case Reports
Penetrating injury to the oral cavity: a case report and review of the literature.
Penetrating injury to the oral cavity, although rare, may cause serious morbidity and mortality in the pediatric population. Impalement injuries are known to cause delayed vascular injury to the internal carotid artery, leading to significant neurologic sequelae. We present an unusual case of impalement injury and make recommendations regarding the successful evaluation and management of such injuries.
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Boerhaave's Syndrome (spontaneous esophageal perforation) is an uncommon clinical entity that frequently presents with an antecedent history of marked vomiting followed by chest or abdominal pain. Misdiagnosis is the most important contributing factor in the continuing high morbidity and mortality of this disease. We report an atypical presentation of Boerhaave's Syndrome in an elderly female who presented to the Emergency Department with dyspnea, right sided chest pain, right pleural effusion, and hypovolemic shock without an identifiable antecedent event. ⋯ Only 36 hours after admission did the diagnosis of Boerhaave's Syndrome become evident. She underwent operative repair and, after a prolonged stay, was discharged in relatively good condition 3 months after her admission. The absence of vomiting prior to presentation and the right sided effusion are the distinguishing features of this particular case.
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Angioedema is a well-known complication of medical therapy with angiotensin-converting enzyme (ACE) inhibitors. Isolated uvular angioedema, a rare presentation of angioedema, in a patient taking lisinopril (Zestril) is described in this case report. Management of uvular edema is also reviewed.
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We describe Alberta's publicly funded system of rural hospital emergency outpatient services just before the profound impact of major health care reforms. From a rural physician's perspective, we descriptively analyze a unique government database that contains the number of emergency outpatient visits to all Alberta hospitals in the fiscal year 1992/93. ⋯ There were significant differences in the emergency outpatient use of large urban, regional urban, and rural hospitals, and between rural hospitals that were close, middle, or remote distances from tertiary or secondary care centers. We identify some clinically important factors that are not described by available data, but which should be considered by the reform movement.