J Emerg Med
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Endotracheal intubation is a common procedure in the emergency department, and new devices may improve intubation time, success, or view. ⋯ The KVVL was slightly faster than Macintosh DL in two of four studied airway scenarios, and had a higher success rate in the difficult cadaver airway scenario. Further study is required in the clinical setting.
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Case Reports
Left-sided Superior Vena Cava and Venous Hyperoxia Masquerading as Inadvertent Carotid Artery Catheterization.
A persistent left-sided superior vena cava (PLSVC) is a rare, often asymptomatic, venous anomaly that may be first diagnosed during central venous catheterization. During chest radiograph interpretation, a PLSVC can be confused with inadvertent arterial catheterization. ⋯ We describe the presentation of a 45-year-old man with end-stage liver disease who required central venous catheterization for treatment of septic shock. An aberrantly placed catheter noted on chest radiograph and an elevated central venous oxygen saturation gave the appearance of inadvertent carotid artery catheterization. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: A persistent left-sided superior vena cava can masquerade as an inadvertent cannulation of the carotid artery during central line placement. It is important for emergency physicians to be aware of this possibility when evaluating a chest radiograph with an aberrantly placed catheter. Venous hyperoxia may further complicate attempts to differentiate between arterial and venous catheterization in patients with septic shock. After confirmatory tests, the emergency physician should consider removal of the catheter due to potential complications.
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Emergency physicians can utilize bedside ultrasound to aid in the diagnosis of abdominal wall hernias and in the reduction of incarcerated hernias. ⋯ A physician trained in bedside ultrasound can diagnose an abdominal wall hernia and facilitate the appropriate treatment of an incarcerated hernia.
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Femoral venous access is an essential part of patient care in the emergency department (ED). However, current medical literature and texts have not dealt with it much using actual patient anatomy. ⋯ Up to 95% of people have some degree of overlap of the femoral vein by the femoral artery. By positioning the leg in an abducted and externally rotated position, the amount of overlap is reduced and the diameter of the vein is increased, maximizing the percentage of the vein available for cannulation.
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Emergency department (ED) crowding is a major international concern that affects patients and providers. ⋯ Return visits impose additional pressure on the ED, because return patients have a significantly longer LOS at the ED. However, the rate of unscheduled return visits and ED crowding was not related. Because this parameter serves as an essential quality assurance tool, we can assume that the studied hospital scores well on this particular parameter.