J Emerg Med
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Comparative Study
The role of an emergency department observation unit in the management of trauma patients.
During a 12-month period, 20,838 patients with acute traumatic injuries were seen in the Emergency Department (ED) of Denver General Hospital. Of these patients, 520 (2.5%) were admitted to the ED Observation Unit, a seven-bed acute care unit situated within the ED and sufficient data were available on 485 (93%) for inclusion into the study. Fifty-three (15.4%) of these observation unit patients required subsequent admission, 389 (80%) were discharged, and 16 (4%) left against medical advice. ⋯ These groups of patients were analyzed and compared with regard to severity of injury, length of stay, and discharge diagnosis. The observation unit is useful in the evaluation of blunt chest or abdominal trauma when work-up, including chest x-ray studies and peritoneal lavage, is initially negative and when drug or alcohol ingestion obscures the initial evaluation in the ED. An observation unit within the ED is cost-efficient and has proven very useful in the management of trauma victims.
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A case of superior patellar dislocation is described. The dislocation was sustained without apparent trauma. Closed reduction was accomplished in the emergency department. No apparent injury to the patellar ligament was sustained.
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Acute otitis media is a common pediatric infection that requires appropriate evaluation of the young child to assure that there are no accompanying systemic infections or complications. The examination of the ear must not only assess the appearance of the tympanic membrane, but determine its mobility. Treatment should be initiated with antibiotics and symptomatic relief. Good follow-up must be arranged.
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Warming plastic bags containing intravenous solutions in a microwave oven (MWO) raised the temperature from 18 degrees C to an average of 34.1 degrees, 40.2 degrees, and 42.8 degrees C when treated for 120, 150, and 160 seconds, respectively. Fluids at 18 degrees C, when passed through a blood warmer, resulted in temperatures at the distal end (DE) of about 27 degrees C; but if the bags were priorly warmed to 42 degrees C, fluids arrived at the DE at a temperature of about 30 degrees C. Fluids heated by MWO to 42 degrees C through a single short tubing 180 cm long arrived at the DE at a temperature of 33.7 degrees C. ⋯ One group of 19 patients undergoing repair of injuries to extremities received infusions warmed by MWO to 42 degrees, while other groups received them at about 20 degrees. After an initial fall, average temperature in the former tended toward normal levels while in the latter, body temperature declined. The simple expedience of MWO warming of the bags to 42 degrees C, and flowing through shorter administration tubing, appears to ameliorate this complication and in some cases prevents it.
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A 39-year-old male arrived in the emergency department with multiple stab wounds to the chest. A pneumopericardium was present on initial chest x-ray study. ⋯ All parameters improved following removal of 100 cc of air by pericardiocentesis. The etiology, diagnosis, pathophysiology, and treatment of tension pneumopericardium are discussed.