J Emerg Med
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Review Case Reports
Soft tissue injection of hydrocarbons: a case report and review of the literature.
Hydrocarbon injection, while commonly seen in domestic accidents or attempted suicide, is not extensively addressed in the literature. This article comprises a review of the various complications of intravascular and soft tissue injection of petroleum distillates, and provides recommendations for patient management. An illustrative case involving the subcutaneous injection of dripless oil, a mixture of mineral oil, nonionic detergents, and petroleum naphtha, is presented.
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Practice Guideline Guideline
Procedural sedation and analgesia in the emergency department. Canadian Consensus Guidelines.
Procedural sedation and analgesia are core skills in emergency medicine. Various specialty societies have developed guidelines for procedural sedation, each reflecting the perspective of the specialty group. Emergency practitioners are most likely to embrace guidelines developed by people who understand emergency department (ED) skills, procedures, conditions, and case mix. ⋯ The guidelines are aimed at non-anesthesiologists practicing part-time or full-time emergency medicine. They are applicable to ED patients receiving parenteral analgesia or sedation for painful or anxiety-provoking procedures. They are intended to increase the safety of procedural sedation in the ED.
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The Toomey syringe and other esophageal detection devices have been shown to be highly sensitive and specific for indicating whether an endotracheal (ET) tube is in the esophagus or the trachea. Many prehospital systems use the Toomey syringe method as the major determinant in deciding whether or not to remove an ET tube after an intubation attempt. We present three cases in which various pulmonary pathologies led to false positive results; that is, Toomey syringe aspiration indicated esophageal placement when the tube was correctly positioned in the trachea. A literature review follows the case reports.
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Concern exists about the ability of Emergency Physicians (EPs) to maintain a career in Emergency Medicine (EM) over a professional lifetime. The objectives of this study were to assess the practice characteristics of residency trained EPs, to document how the EP's responsibilities evolve throughout a career, and to assess career longevity. A retrospective cohort study using a mailed questionnaire was used to document practice characteristics, evolution of responsibility, and career longevity from all physicians who graduated from allopathic EM residencies between 1978-1988 (inclusive). ⋯ Responders who were more likely to remain in EM included those who had higher reimbursement, were board certified in EM, or did not train in another specialty or do a fellowship outside of EM. Throughout the 15-year careers studied, EPs noted a significant shift in the time spent doing clinical work (decreased) and the time doing administrative work (increase). The attrition from EM practice for this cohort was < 1% per year.
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Oral ingestion of baking soda (sodium bicarbonate) has been used for decades as a home remedy for acid indigestion. Excessive bicarbonate ingestion places patients at risk for a variety of metabolic derangements including metabolic alkalosis, hypokalemia, hypernatremia, and even hypoxia. ⋯ We present two cases of severe metabolic alkalosis in patients with unsuspected antacid overdose. The presentation and pathophysiology of antacid-related metabolic alkalosis is reviewed.