J Emerg Med
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Randomized Controlled Trial Comparative Study Clinical Trial
Cricothyrotomy technique: standard versus the Rapid Four-Step Technique.
Standard cricothyrotomy technique uses a tracheal hook cephalad to the opening to stabilize the trachea during endotracheal (ET) tube passage. A newly described Rapid Four-Step Technique (RFST) uses the tracheal hook caudal to the opening to stabilize the trachea during ET tube passage. This experimental crossover trial compared standard cephalad tracheal hook traction to caudad traction as recommended by RFST in a cadaver model of cricothyrotomy. ⋯ There was no significant difference between maximal ET tube sizes for standard technique (median size 7.0, mean 6.95 mm internal diameter) versus RFST (median size 7.0, mean 6.82 mm internal diameter). We conclude that RFST may be associated with a higher incidence of complications than standard technique as demonstrated by our cadaver model of cricothyrotomy. We were unable to demonstrate a difference between the two techniques with regards to size of ET tube able to be passed.
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Review Case Reports
Thyrotoxic periodic paralysis: a case report and review of the literature.
Hypokalemic periodic paralysis occurring in thyrotoxicosis is rare in Caucasians and is not often highlighted as an endocrine emergency. Periodic paralysis, without familial background, manifests only in the thyrotoxic patient. ⋯ We report an unusual case of acute onset weakness from thyrotoxic periodic paralysis in a young Chinese migrant who had a normal serum potassium level at the time of initial presentation, though on subsequent presentation one week later, he had the typically associated hypokalemia. We also review the literature on thyrotoxic periodic paralysis.
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Carbon monoxide (CO) poisoning continues to be a significant health problem both in the United States and in many other countries. CO poisoning is associated with a high incidence of severe morbidity and mortality. Epidemics of CO poisoning commonly occur during winter months and sources include: smoke from fires, fumes from heating systems burning fuels, and exhaust fumes from motor vehicles. ⋯ The clinical presentation is non-specific and may range from nausea and headache to profound central nervous system dysfunction. The mainstay of therapy for CO poisoning is supplemental oxygen, ventilatory support, and monitoring for cardiac dysrhythmias. This article reviews up-to-date information of this potentially devastating exposure.
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Thyrotoxic periodic paralysis is a rare endocrine disorder most prevalent among individuals of Asian descent that presents as proximal muscle weakness, hypokalemia, and signs of hyperthyroidism. We present the case report of a patient with previously undiagnosed hyperthyroidism, protracted muscle weakness with transient exacerbations, and nocturnal onset of periodic paralysis affecting the upper and lower limbs.
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This article reviews the pertinent literature related to the selection process of medical students to emergency medicine residency programs. The impact that academic performance in medical school, the interview, letters of recommendation, and other achievements have on the performance of the future resident are reviewed. All articles identified by an English language MEDLINE search were reviewed by the authors as to significance to the subject. Review of relevant literature indicates that no precise correlation can be made between performance in medical school and achievements during the residency, although there seems to be a correlation between academic performance in medical school and similar performance on board certification examinations.