The Journal of the Kentucky Medical Association
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Potential phrenic nerve injury that results in diaphragmatic dysfunction and respiratory insufficiency has important implications for the anesthesiologist who must insure adequate ventilation and gas exchange. A variety of traumatic injuries as well as some surgical manipulations have been identified with an increased frequency of diaphragmatic paralysis. We have observed the occurrence of this sequelae after scalenotomy for thoracic outlet obstruction, a previously unreported association.
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The etiology of most penetrating neck injuries is caused by missiles or stabbings. Irrespective of the cause of injury, management strategies require that life-threatening injuries to underlying deep neck structures such as esophagus, trachea, or carotid artery be promptly identified. A case is reported in which occlusion of the common carotid artery resulted from a dog bite to the neck. ⋯ The carotid injury was identified by preoperative angiography and was repaired with a reversed saphenous vein interposition graft. The patient had full recovery without neurologic sequela. While injuries to deep neck structures as a result of animal bites are rare, these patients should be evaluated according to accepted protocols to exclude or identify such life-threatening injuries.
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Changes in medical education and the practice of medicine have resulted from the push for both education and health care reforms. Undergraduates planning application to medical school should broaden their preparation to include communications, computers, economics, and multicultural educational experiences. To prepare graduates for medical practice in the new millennium, the University of Kentucky College of Medicine has implemented a new curriculum focusing on integration of basic and clinical sciences, primary care in ambulatory sites, health promotion and disease prevention, and attention to the ethical, social, psychologic, and financial impact of disease upon the patient, family, and society.
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Multicenter Study
Automated external defibrillators used by emergency medical technicians: report of the 1992 experience in Kentucky.
Automated external defibrillators (AED) have been authorized for use by Emergency Medical Technicians (EMT) in Kentucky since March 1991. Emergency Medical Services (EMS) which use these devices are required to submit annual reports to the EMS Branch. During 1992, 17 services were approved to use AEDs. ⋯ This percentage is comparable with the survival rates reported from other predominately rural states where AEDs have been used by EMTs. Possible protocol violations and inadequate documentation were also identified from these reports. In summary, EMTs in predominately rural Kentucky can use AEDs to achieve survival rates for out-of-hospital cardiac arrest comparable with other rural states.