J Emerg Med
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Successful airway management is critical to the practice of emergency medicine. Thus, emergency physicians must be ready to optimize and prepare for airway management in critically ill patients with a wide range of physiologic challenges. Challenges in airway management commonly encountered in the emergency department are discussed using a pearl and pitfall discussion in this second part of a 2-part series. ⋯ This narrative review discusses the pearls and pitfalls of commonly encountered physiologic high-risk intubations with a focus on the emergency clinician.
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Motorcycle crash-related injury mechanism is a criterion in the Centers for Disease Control and Prevention field triage guidelines of injured patients, with a recommendation to transport affected patients to a trauma center need not be the highest level. ⋯ Patients with motorcycle crash-related injuries treated at higher-level trauma center (I or II) had increased survival. This warrants a re-evaluation and adjustment of the field triage criterion for such patients. Examining the evidence behind field triage guidelines in trauma systems is needed for improved patient outcomes.
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Meta Analysis
Double Defibrillation for Refractory In- and Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis.
Double/dual defibrillation (DD) has been proposed as an alternative treatment for refractory ventricular fibrillation (VF). This topic has been poorly researched and data on survival rates are limited. ⋯ DD did not improve any outcomes of interest. Therefore, it is imperative that a well-designed study in this area be conducted. Ideally, conducting a randomized controlled trial in this population should be attempted to obtain a higher level of scientific evidence.
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Cervicofacial subcutaneous emphysema can occur rarely after a dental procedure, especially tooth extraction, and can be misdiagnosed as an allergic reaction or post-procedure swelling. ⋯ We report a rare case of a 29-year-old man who developed extensive cervicofacial subcutaneous emphysema after a dental hygiene procedure. A review of the relevant literature is presented in our report. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early identification and management of this potentially life-threatening condition is particularly important and can prevent serious complications, leading to improved patient outcomes.
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Case Reports
Vitriolage by Sulfuric Acid: Unique Challenges and Considerations in Patient Resuscitation.
In the United States, over 1 million burns require medical treatment each year. Chemical burns represent an infrequent but devastating percentage of all burns, which account for a large proportion of all burn-related deaths. Of the various causes of chemical burns, sulfuric acid is most commonly involved in occupational and accidental burns, and even cases of assault. ⋯ We describe the case of a 27-year-old man who presented to our Emergency Department (ED) after an assault with sulfuric acid. During his presentation, particular attention and care was given to his decontamination, airway management, and correction of life-threatening metabolic derangements. After stabilization in the ED he survived an extensive hospital admission. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patient outcomes and prognosis after chemical burns are dependent on prompt recognition/suspicion and rapid initiation of treatment. Even with prompt treatment, severe physiologic and psychologic injuries often afflict the patient. While encountering these devastating injuries, the emergency physician must carry a heightened sense of care and protection for both patient and staff to ensure optimum outcomes.