J Emerg Med
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Modern dental care and use of antibiotics for oral infections have made Ludwig's angina rare. To avoid acute airway obstruction, emergency physicians must be able to rapidly recognize and treat this condition. A typical case of Ludwig's angina is presented, followed by a review of clinical findings and therapeutic modalities. Emphasis is made on airway management, antibiotics, and surgical drainage.
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Dementia is a relatively common syndrome seen in the elderly emergency department population. The emergency physician usually sees demented patients secondary to behavioral complications. Diagnosing the syndrome of dementia principally consists of ruling out treatable causes, which can be performed either in an in-patient or out-patient location. ⋯ Complications that are primarily treated non-pharmacologically include circadian rhythm disturbance, catastrophic reaction (excessive emotional response), and wandering, as well as some mild verbal outbursts and delusions. Pharmacologic interventions are usually necessary for agitation, physical attacks, and significant delusions or hallucinations. Neuroleptic medication is the principal pharmacologic class with which to treat these symptoms, although benzodiazepines are also effective.
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Much of today's medical care relies on experience unsupported by investigation, and emergency medical care is no exception; research is necessary to improve this care. Critically ill and injured patients are the patients who will benefit the most from improvements in emergency medical diagnostic and treatment methods. Yet, the federal bureaucracy has effectively banned research on these patients, since they cannot generally give "informed consent." We argue that, with the proper safeguards, research on critically ill and injured patients should be performed in the emergency medicine (EDs and EMS) settings without informed consent. To require such consent when not obtainable compromises both the researchers who must get such consent and the patients who must continue to endure old, and often untested therapies.
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Numerous authors have recommended reusing vials of the tissue adhesive Histoacryl blue, despite the fact that it is manufactured for single use. The purpose of this study is to determine if Histoacryl vials become contaminated during reuse and to determine its inhibitory effects on various microbial pathogens. Ten consecutive vials used multiple times were collected from two hospitals, and the residual adhesive was cultured. ⋯ There was no growth from any vials. Testing against microbial pathogens showed that the tissue adhesive is particularly effective at inhibiting gram-positive organisms. This study demonstrates that Histoacryl vials do not become contaminated after repeated use and that the tissue adhesive has an antibacterial effect that may be beneficial in the management of wounds.