Annals of emergency medicine
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Case Reports
Iatrogenic bilateral tibial fractures after intraosseous infusion attempts in a 3-month-old infant.
A 3-month-old girl presented to the emergency department with a clinical picture compatible with sepsis. When peripheral IV cannulation could not be attained, intraosseous (IO) access was attempted unsuccessfully in both tibias as well as in the right femur. ⋯ Radiographs revealed healing fractures of both proximal tibias. This case represents a previously unreported complication of intraosseous infusions and underscores the need for the use of proper technique and equipment.
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We reviewed the medical records of all patients who delivered in the prehospital or emergency department setting from 1980 through 1987 at Hennepin County Medical Center. There were 80 deliveries. Twelve women had no prenatal care; the remaining 68 women had an average of seven prenatal visits. ⋯ Twenty infants required some degree of resuscitation at the time of delivery, including 19 endotracheal intubations. Complications during delivery were numerous and included nuchal cord, breech presentation, shoulder dystocia, postpartum hemorrhage, pre-eclampsia, prolapsed cord, and meconium staining. Prehospital and ED delivery were associated with a high rate of maternal and infant complications.
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We reviewed 35 consecutive cases of post-traumatic pulmonary contusion in children that occurred during a 12-year period. Of these, 19 children (54%) were more than 5 years old, 30 (86%) were involved in motor vehicle accidents, and 29 (83%) had multiple trauma. External thoracic wall contusion, fracture of the bony thorax, tachypnea, hemoptysis, and abnormal breath sounds were frequently absent on presentation. ⋯ Pulmonary contusion in children is usually a consequence of significant-impact injury associated with multiple trauma and has a good prognosis. Despite a paucity of abnormal physical findings, children who sustain high-impact trauma should receive radiographic evaluation of the chest to assess for possible intrathoracic injury. When pulmonary contusion is accompanied by fracture of the bony thorax, serial radiographic evaluation of the chest should be performed during the initial 48 hours of hospitalization.
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Medical students are trained in airway management by endotracheal intubation in most medical schools. Unfortunately, little data exist examining retention, and no data exist that actually break down the steps of intubation to determine where students encounter problems. ⋯ The most frequent errors during intubation were failure to check the light before intubation, use of the teeth as a fulcrum, and failure to check the cuff on the endotracheal tube. Knowledge of the most common errors will allow instructors to place greater emphasis on those areas during the initial instruction period with a focus on decreasing their occurrence in the future.
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Because of discontinuation of base hospital participation, paramedics in a large urban zone of a California emergency medical services (EMS) system serving 1.1 million persons went on emergency standing orders for nearly all calls requiring advanced life support. Subsequently, the base hospital resumed medical control function under limited standing orders. ⋯ There were significant differences in total prehospital care times and at-scene times between the control group and the two standing order groups (P less than .01). There are important implications to EMS systems that use extensive base hospital contact.