Annals of emergency medicine
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Practice Guideline Guideline
Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures.
This clinical policy focuses on critical issues in the evaluation and management of adult patients with seizures. The medical literature was reviewed for articles that pertained to the critical questions posed. ⋯ Level A recommendations represent patient management principles that reflect a high degree of clinical certainty; Level B recommendations represent patient management principles that reflect moderate clinical certainty; and Level C recommendations represent other patient management strategies based on preliminary, inconclusive, or conflicting evidence, or based on consensus of the members of the Clinical Policies Committee. This clinical policy is intended for physicians working in hospital-based EDs.
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The early detection of intracranial hypertension can lead to timely medical and neurosurgical intervention, preventing brain herniation and death. In this investigation, we hypothesize that an increase in intracranial pressure can be detected by an increase in intraocular pressure using noninvasive existing technology, the handheld tonometer. ⋯ Abnormal intraocular pressure as measured with the handheld tonometer is an excellent indicator of abnormal intracranial pressure in patients with known intracranial pathology.
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An experienced intensivist performed an emergency endotracheal intubation on a 72-year-old woman without difficulty. The vocal cords were visualized during the intubation. An esophageal detector device was used to confirm correct airway placement. ⋯ It is postulated that aspiration of the syringe on the esophageal detector device suctioned the mucus plug from the bronchial tree into the endotracheal tube and precluded ventilation of the airway. This complication has not been previously reported. The utility and possible hazards of the esophageal detector device are discussed.