Annals of emergency medicine
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We present the case of a 28-year-old man admitted to a Level I trauma center after a motorcycle crash in which he sustained blunt trauma to the face and neck, including a mandibular ramus fracture. The patient had no airway compromise on admission, but he acutely developed significant partial upper airway obstruction necessitating emergency endotracheal intubation and subsequent tracheostomy approximately 36 hours after admission. ⋯ Potential causes of this complication are presented, and signs and symptoms of upper airway obstruction and airway management strategies are discussed. The etiology of traumatic upper airway obstruction is reviewed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Droperidol versus haloperidol for chemical restraint of agitated and combative patients.
To compare two related pharmacological agents used for the chemical restraint of agitated and combative patients. ⋯ In equal IM doses (5 mg), droperidol results in more rapid control of agitated patients than haloperidol, without any increase in undesirable side effects.
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Comparative Study
Adult minor trauma patients: good outcome in small hospitals.
To determine if adult minor injury trauma admissions to small hospitals have a mean length of stay (LOS) and fatality rate similar to those of admissions to larger hospitals. ⋯ For minor trauma patients, smaller hospitals have a shorter mean LOS and a similar fatality rate when compared with larger hospitals and Level I and II trauma facilities. Despite a low ISS, admitted elderly patients have a higher death rate regardless of hospital size.
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One of the continuing controversies in aeromedical transport involves crew composition. Since 1987, we have used both physician/nurse (P/N) and nurse/nurse (N/N) crews to staff two identically equipped helicopter ambulances. The purpose of this study was to compare the severity of illness or injury and outcomes of patients transported by P/N and N/N crews. ⋯ No objective differences in outcome of patients were found between P/N and N/N teams. Although small differences were found in types of flights taken by P/N and N/N teams, there were no differences in objective measures of severity between the two teams. We find no objective evidence to prefer one crew composition over another.
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To develop decision rules that will predict fractures in patients with ankle injuries, thereby assisting clinicians in being more selective in their use of radiography. ⋯ Highly sensitive decision rules have been developed and will now be validated; these may permit clinicians to confidently reduce the number of radiographs ordered in patients with ankle injuries.