Annals of emergency medicine
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Automatic skin staplers have been commonly used for surgical wound closure for many years. The efficiency and ease of placement of skin staplers make them an attractive alternative to suture repair of selected lacerations in the emergency department. Emergency physicians, however, have been reluctant to use staplers in the ED. ⋯ No infectious complications, delayed wound healing, or cosmetic problems were seen. Skin stapling was easier and quicker than suture repair at a lower overall cost in most circumstances. Our study shows skin stapling to be an efficient and cost-effective alternative method to suture wound closure for selected lacerations in patients presenting to the ED, without compromising wound healing or cosmetic results.
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We report the case of a 74-year-old man who presented to our emergency department with complaints suggestive of a urinary tract disease. After examination failed to reveal another etiology for his symptoms, antibiotic therapy was initiated and the patient was discharged. ⋯ Autopsy revealed a ruptured abdominal aortic aneurysm. Our case highlights the varied presentations of abdominal aortic aneurysm, which often go unrecognized, and the need to diligently search for this life-threatening affliction.
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Patients presenting to the emergency department who refuse recommended treatment present substantial management and medicolegal problems for the emergency physician. Members of the Jehovah's Witness religion, who number approximately 700,000 in the United States, create specific medical, ethical, and legal challenges when they require but refuse necessary blood component therapy. ⋯ A protocol is presented for responding to opposition to transfusions by Jehovah's Witnesses. The protocol should increase the likelihood of an effective medical and ethical response by emergency physicians and should help to protect against potential legal actions.
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The technique of intraosseous infusion is a life-saving emergency alternative when IV access is impossible or will be critically delayed. Concerns about its safety remain, especially concerning the risk of bone marrow and fat emboli to the lungs. We examined autopsy pulmonary specimens on two children who had received intraosseous infusions during resuscitation attempts and found an average of 0.23 to 0.71 bone marrow and fat emboli per mm2 of lung. ⋯ Four hours after infusion, the animals were killed, and representative sections of the lung were examined with oil red-0 and hematoxylin and eosin stains for the presence of fat and bone marrow emboli. Fat and bone marrow emboli were found in all lung sections, varying from 0.11 to 4.48 emboli/mm2 lung (mean, 0.91 emboli/mm2 lung) for the emergency drugs and solutions and 0.06 to 0.53 emboli/mm2 (mean, 0.29 emboli/mm2 lung) for the controls. Analysis of variance revealed no significant difference (P = .07) in mean number of fat and bone marrow emboli per square millimeter of lung among the emergency drugs and compared with controls.(ABSTRACT TRUNCATED AT 250 WORDS)