J Emerg Med
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Review Case Reports
Delayed presentation of spinal stab wound: case report and review of the literature.
Stab wounds to the spinal cord are relatively uncommon in North America, but even rarer is the presentation of such an injury in a delayed fashion. We report a case of a 31-year-old male who presented with neurologic deficit 4 weeks after a stab wound injury to the spine. Because of worsening neurologic deficit, the retained knife fragment was operatively removed, and the patient had an uneventful recovery. The management of such an injury is discussed, with a review of the literature.
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Randomized Controlled Trial Clinical Trial
Endotracheal lidocaine administration via an esophageal combitube.
The purpose of this study was to test the hypothesis that lidocaine is systemically absorbed after administration via a Combitube placed in the esophagus, and that therapeutically significant plasma lidocaine concentrations can be attained using this route with standard endotracheal doses (2.0 mg/kg). During general anesthesia, 27 elective surgical patients received 2.0 mg/kg lidocaine (diluted as necessary with 0.9% saline to a minimum total volume of 10 mL) via a Combitube (study group, n = 13) or an endotracheal tube (control group, n = 14). Venous blood samples were drawn for 3 h after lidocaine administration and plasma concentrations determined by gas chromatography using a nitrogen-phosphorus detector (NPD). ⋯ No patients reported chest discomfort or dyspnea upon awakening, and no other side effects were noted. In support of the hypothesis, administration of lidocaine via an esophageal Combitube results in systemic drug uptake; however, at conventional endotracheal doses, plasma concentrations are subtherapeutic. It remains to be determined whether higher doses of lidocaine administered via an esophageal Combitube will result in therapeutic plasma concentrations.
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Comparative Study
Base deficit level indicating major injury is increased with ethanol.
Analyses were performed to determine whether ethanol increases base deficit, independent of major injury, in blunt trauma patients from two Level I trauma centers. In 2140 Baltimore patients, base deficit was significantly higher in ethanol-positive patients (blood level > or =0.01%), independent of blood pressure (BP), Injury Severity Score (ISS), and blood loss. In 139 Youngstown, Ohio, patients, base deficit was significantly higher in ethanol-positive patients, independent of ISS and RBC units given. ⋯ A base deficit < or =-4.1 for ethanol-positive and < or =-1.1 for ethanol-negative patients had higher rates of major injury (odds ratio 3.2 and 2.1, respectively) and abdominal trauma (odds ratio 3.6 and 3.2, respectively). In blunt trauma patients, base deficit is increased with ethanol, independent of major injury. A base deficit of < or =-4.1 for ethanol-positive and < or =-1.1 for ethanol-negative awake patients may be an early warning for occult injury and suggest the need for an abdominal computed tomography (CT) scan or ultrasound.
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Comparative Study
"Medical clearance" of psychiatric patients without medical complaints in the Emergency Department.
This study was conducted to evaluate the benefit of comprehensive "medical clearance" (history, physical examination, vital signs, laboratory, radiography) in patients presenting to the Emergency Department (ED) with isolated psychiatric complaints. All patients 16 years and older who presented with a psychiatric complaint and required a psychiatric evaluation before discharge from the ED were included in the study. Data, obtained in a 5-month consecutive, retrospective chart review, included patient age, sex, initial complaint, past medical and psychiatric history, initial vital sign measurement, physical examination findings, laboratory analysis (electrolytes, complete blood count, toxicology screen), chest X-ray study results, and final disposition. ⋯ The remaining 132 patients (62%) presented to the ED with medically based chief complaints or past medical history requiring further evaluation in the ED before discharge. The initial complaints of these patients correlated directly with the need for laboratory and radiographic "medical clearance" in the ED. Patients with a primary psychiatric complaint coupled with a documented past psychiatric history, negative physical findings, and stable vital signs who deny current medical problems may be referred to psychiatric services without the use of ancillary testing in the ED.
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Comparative Study Clinical Trial
Cardiac output measurement with an esophageal doppler in critically ill Emergency Department patients.
Cardiac output (CO) is a principal determinant of perfusion in many critically ill patients. The objectives of this study were to determine whether physicians' estimates of CO, or cardiac index (CI), are accurate compared with CO/CI measured by esophageal doppler, and to estimate the physician time necessary for Emergency Department (ED) CO/CI measurement. We prospectively evaluated a convenience sample of critically ill, adult ED patients. ⋯ The mean time for optimal doppler signal was 5.7+/-4.3 min. Physicians' estimates of CI were inaccurate compared with measured CI. Esophageal doppler measurement of CO/CI appears to be practical from a physician time standpoint.