Annals of emergency medicine
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Injuries to the lower genitourinary tract may occur with penetrating or severe blunt lower abdominal trauma. Commonly associated findings are pelvic fractures and gross hematuria or a bloody urethral discharge. ⋯ We recommend retrograde urethrography in male patients with a pelvic fracture or significant lower abdominal or perineal trauma without a fracture when associated with gross hematuria, a bloody urethral discharge, inability to void, swelling, ecchymosis or hematoma of the perineum or penis, or a "high-riding" or boggy prostate. Cystography should follow urethrography after a urethral injury has been excluded.
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The goal of culturing abscesses and/or cellulitis is to identify the offending pathogen in order to understand and treat the infection. Abscesses respond to incision and drainage. Antibiotics are not indicated in the patient with normal host defense, and thus in these patients cultures and Gram stains are not indicated. ⋯ Although not specific, certain types of cellulitis show different clinical characteristics. Treatment with elevation, warm soaks, and antibiotics is still the mainstay of therapy. Gram stain and culture are limited to those patients who do not respond to initial therapy or who are immunocompromised.
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In spite of all the scientific and technical advances in recent years, shock that is not rapidly correctable with fluid can have a morbidity rate exceeding 80%. Consequently awareness of such precipitating factors as sepsis and early diagnosis and treatment are essential. Treatment should be rapid and should follow a previously outlined protocol. ⋯ Diuretics may occasionally help prevent renal failure in patients who are persistently oliguric after blood flow and pressure are restored. Heparin is occasionally of value if DIC develops with no concomitant fibrinolysis. Antibiotics are important in septic shock and may also be important if persistent shock has reduced gastrointestinal mucosal integrity so that bacteria and bacterial products can enter the portal system.(ABSTRACT TRUNCATED AT 400 WORDS)
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Contemporary cerebral-cardiopulmonary resuscitation investigations in the experimental laboratory have defined mechanisms for blood flow during closed-chest CPR and have demonstrated that the current CPR technique produces limited systemic perfusion. Modified closed-chest CPR techniques usually improve perfusion. Unfortunately few laboratory CPR studies have actually investigated resuscitation and survival. ⋯ The role and benefit of open-chest CPR have yet to be determined, because this technique will most likely be used after conventional CPR failure. New and different experimental models are required to meet clinical needs and challenges. The alliance between practitioner and investigator should be strengthened if common goals are to be attained.
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Standard external CPR (SECPR) steps A, B, and C can maintain the brain's viability if started immediately, but not after prolonged arrest times. "New CPR" (simultaneous ventilation-compression CPR, SVC-CPR) is not suitable for basic life support, and may not be physiologically superior to optimally performed SECPR. The superiority of interposed abdominal compression CPR (IAC-CPR) over SECPR for basic life support is also uncertain. Open-chest CPR is physiologically superior to all external CPR methods studied thus far. ⋯ Barbiturates have been shown to exert no breakthrough effect on outcome after cardiac arrest, but are safe in the hands of those skilled in advanced intensive care. Barbiturates may be of adjunctive value after prolonged cardiac arrest, particularly when used to suppress seizures, facilitate controlled ventilation, and reduce intracranial pressure. Calcium entry blockers have been shown in animal models to improve hemodynamics and cerebral outcome postarrest, but not consistently.(ABSTRACT TRUNCATED AT 250 WORDS)