Harefuah
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To assess the efficacy of prehospital coniotomy (cricothyrotomy), information regarding all coniotomies performed by military physicians during the last 3.5 years was analyzed. 26 were performed between October 1991 and May 1995, of which 23 were successful (88.4%). Failures were due to poor anatomic identification of the cricothyroid membrane. Most patients suffered head or neck injuries (in 61.5% and 19%, respectively). ⋯ Since coniotomy is a life-saving procedure, it should be part of the armamentarium of any physicians. Coniotomy in the field is associated with a high success rate. The procedure is recommended in trauma victims who need airway establishment and cannot be intubated or in whom intubation has failed.
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Despite growing recognition that patients in delirium merit the full facilities of general hospitals, they still continue to be admitted to psychiatric hospitals. The Israel national psychiatric case register data of psychiatric in-patients with delirium was examined. During 1984-1993, 805 patients with a diagnosis of delirium were admitted to psychiatric hospitals, constituting 0.86% of total psychiatric admissions. 4 major categories were identified: dementia with delirium (33.4%) delirium tremens (DT; 26.9%), drug-induced delirium (10.0%) and acute and, subacute delirium (29.5%). ⋯ These outcome variables were much lower in DT and drug-induced delirium. The issue of "justification" of psychiatric hospitalization of cases of delirium is discussed. More accurate screening is suggested, as well as wider collaboration with other facilities responsible for the management of delirious patients.
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A fragment of a fractured tracheostomy tube as a foreign body in the bronchus is very unusual. We report an 18-year old male with Hunter's syndrome who presented with fever and bronchorrhea. ⋯ Chest X-ray showed an opaque foreign body in the right main bronchus which was removed through a flexible bronchoscope and found to be a piece of the broken edge of the outer cannula of a tracheostomy tube. We suggest regular examination of tracheostomy tubes for signs of wear-and-tear and recommend their periodic renewal before they become worn out.
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Penetrating cardiac injury is often fatal. Patients present with a variety of clinical patterns, from a stable patient but with an insidious course, to those admitted with waning vital signs. In all cases prompt diagnosis and treatment are crucial. A series of 98 cases is presented, emphasizing the problems in diagnosing this condition and recommending the way such patients should be triaged and treated.