Annals of emergency medicine
-
To determine the effects of early fluid resuscitation on the rate, volume, and duration of hemorrhage using a sheep model of uncontrolled pulmonary vascular hemorrhage. ⋯ In this sheep model of uncontrolled pulmonary vascular hemorrhage, immediate fluid resuscitation significantly increased the rate, volume, and duration of hemorrhage. The vigorous administration of fluids to patients with penetrating chest trauma has the potential to significantly increase blood loss.
-
Review Comparative Study
Ultrasound in the evaluation and management of blunt abdominal trauma.
Failure to detect intraabdominal injury in the patient with blunt trauma may result in significant morbidity and mortality. The diagnosis of abdominal injury remains a clinical challenge. Presented here is a review of recent literature comparing ultrasound with diagnostic peritoneal lavage and computed tomography in the evaluation of blunt abdominal trauma.
-
We anticipate that over the next few years, emergency physician use of emergency department ultrasound will become the standard of care. However, many EDs are hampered in their efforts to gain hospital approval for emergency physician use of ultrasound because of the lack of publicized information regarding the goals of such use, the scope of emergency physician ultrasound privileges, emergency physician ultrasound credentialing criteria, and ED ultrasound quality-improvement plans. In this article we address these issues and provide an example of a proposal used successfully to gain hospital approval for ED use of ultrasound by emergency physicians.
-
Clinical Trial Controlled Clinical Trial
Incision and drainage of cutaneous abscesses is not associated with bacteremia in afebrile adults.
To determine the prevalence of bacteremia associated with incision and drainage (I&D) of cutaneous abscesses in afebrile adult emergency department patients. Such information has implications for the ED management of immunocompromised patients, patients with history of endocarditis, and patients with prosthetic appliances such as heart valves and artificial joints. ⋯ I&D of localized cutaneous abscesses in afebrile adults is unlikely to result in transient bacteremia. Larger studies are needed to determine whether routine antibiotic prophylaxis is necessary for afebrile patients undergoing I&D.
-
To determine whether neutrophil adherence was altered in the presence of systemic inflammatory response syndrome (SIRS) and infection or severe sepsis. ⋯ Neutrophil adherence was significantly decreased in patients with SIRS and severe sepsis compared with that in normal controls. A larger study enrolling consecutive SIRS subject at risk for severe sepsis may demonstrate whether this assay could be useful in managing sepsis in the ED.