J Emerg Med
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Ortho-chlorobenzylidene malononitrile (CS) "tear gas" is a lacrimating riot control agent causing eye irritation, excessive lacrimation, and blepharospasm. Diphoterine has been efficacious for decontamination of a wide variety of eye and skin chemical splashes and was tested in CS exposure. Five French Gendarmes either entered a standard training CS exposure chamber, developed eye or skin signs and symptoms, and were post-exposure decontaminated with Diphoterine or used Diphoterine as pre-CS exposure prophylaxis in the eyes and on the face before entering the chamber. ⋯ After post-exposure Diphoterine decontamination, in four Gendarmes these effects rapidly resolved and they were fully operational. When Diphoterine was applied to the eyes and face before entering the CS chamber, the expected effects did not occur and the single Gendarme remained fully operational on exiting the chamber. These results suggest that Diphoterine can prevent or rapidly ameliorate the ocular and dermal effects of CS and allow law enforcement personnel to remain fully operational or rapidly regain operational status after decontamination.
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Comparative Study Clinical Trial
Subarachnoid hemorrhage diagnosis by computed tomography and lumbar puncture: are fifth generation CT scanners better at identifying subarachnoid hemorrhage?
This study sought to determine the sensitivity and specificity of modern computed tomography (CT) scans for the diagnosis of subarachnoid hemorrhage (SAH). No studies have been done recently with fifth generation CT scanners to look at the diagnosis of SAH. A retrospective chart review was done of Emergency Department (ED), laboratory, and hospital records at Pitt County Memorial Hospital in Greenville, North Carolina over 1 year from January 1, 2002 to December 31, 2002. ⋯ There were 177 patients who presented to the ED with headache and went on to have a CT scan and an LP to rule out SAH. No patients who had a negative CT were found to have a subarachoid hemorrhage. It is concluded that fifth generation CT scanners are probably more sensitive than earlier scanners at detecting SAH.
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In this study, two mathematical equations were used to calculate and establish the actual Emergency Medicine workforce needed in Puerto Rico (PR) and project the time frame to meet the actual demand. 1) Supply equals the number of existing Emergency Physicians (EPs) plus residency-trained graduates in EM per year minus the annual attrition rate (3%); and 2) Demand equals six (6) full time equivalent positions per Emergency Department (ED) times the total number of EDs in PR. Under both scenarios tested, the significant EP shortage in PR will continue until 2044. ⋯ There is an actual significant shortage in the Puerto Rico EP workforce. It will take a long time to make leaders understand the positive impact of having residency-trained EPs in every ED, on quality patient care and the whole health care system.
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Acute angle closure glaucoma is an ocular emergency that is treatable with prompt and appropriate intervention. Recognition of this disease entity is sometimes difficult. We report a case of bilateral acute angle closure glaucoma in a 55-year-old, otherwise healthy individual, and discuss the different ways the condition may present. The anatomic and pathophysiologic progression leading to an event of angle closure is discussed and treatment modalities available to the Emergency Physician are presented.