J Emerg Med
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Falls in the elderly leading to closed head trauma represent a significant cause of morbidity and mortality in that population, but are not well-characterized. The purpose of this study was to determine the mechanism of fall, outcome, and additional risk factors in elderly patients who require cranial computed tomography (CT) scan after a fall. We conducted a retrospective case series of patients age 60 years and older with closed head trauma secondary to falling who underwent CT scan in the emergency department (ED). ⋯ We conclude that among elderly patients who fall and present to an ED with evidence of closed head trauma, a significant percentage will have abnormal CT scans but only a small minority will require neurosurgery. While falls from standing are more common, falls on stairs or from height are associated with a higher risk of having an abnormal CT scan. A focal neurologic examination is a strong predictor of the need for neurosurgical intervention.
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A patient with sleep apnea syndrome, concurrently taking clonidine as an antihypertensive, presented with severe respiratory acidosis, hypotension, and associated central nervous system depression. Acidosis was improved by mechanical ventilation, and central nervous system (CNS) depression and hypotension were reversed with yohimbine. Clonidine may have an additive CNS depressive effect in sleep apnea syndrome and should be used with caution in such patients. Yohimbine's sympathetic-enhancing effects may be useful in clonidine toxic states.
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This study's objective was to determine the current level and breadth of flight paramedic scope of practice. A six-item survey of lead flight paramedics in 158 air medical programs addressed five issues: 1) Certifications required above state certification; 2) Procedures included in scope of practice; 3) Medications flight paramedics are allowed to administer; 4) Requirements needed to expand scope of practice; and 5) Views on establishing a National Flight Paramedic Certification to alter their scope of practice. Eighty programs out of the 90 respondents (89%) stated that they utilize flight paramedics. ⋯ Eighteen respondents (23%) believe that the development of a National Flight Paramedic Certification Program would alter their scope of practice. In conclusion, flight paramedic scope of practice varies enormously. Since most medical directors have the authority to alter flight paramedic scope of practice and few programs believe that a National Flight Paramedic Certification would alter their practice, medical directors should work directly with flight paramedics to expand their scope of practice.
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The esophageal detector device is a useful, inexpensive, portable device for the detection of inadvertent intubation of the esophagus. It has been extensively tested. It is very accurate with occasional false negatives for tracheal intubation but only two reported cases of false positives for tracheal intubation previously described. This article presents two further cases of false positives for tracheal intubation using the esophageal detector device and warns that although it is the more accurate of the cheap and portable devices available, it is not perfect.
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Non-convulsive status epilepticus (NCSE), a neurological emergency, is reported to account for approximately 25% of patients presenting in status epilepticus. Diagnosis of NCSE can be delayed or missed because of its often subtle presentation. ⋯ We report the case of a 46-year-old man with idiopathic hypoparathyroidism who presented in NCSE secondary to hypocalcemia. As in patients with convulsive status epilepticus, rapid diagnosis and treatment of patients in NCSE is critical to prevent permanent neurological damage.