Annals of emergency medicine
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All adult patients (102 cases) presenting to Bellevue Hospital Medical Center over a calendar year (1978) with core temperatures less than 35 C were studied. Statistically significant correlations between hypothermia and mortality were identified according to mental status, hypoxia, hypotension, hyperamylasemia, duration and severity of hypothermia, and history of exposure and alcohol ingestion. Mortality could not be predicted on the basis of season, age (if greater than 40 years old), sex, presence of infection, or presenting temperature (if greater than 26 C). ⋯ Prolonged hypothermia was uniformly associated with profound underlying medical disease. In patients presenting with temperatures less than 26 C, 50% of deaths resulted from temperature-induced ventricular arrhythmias. Alcoholics hypothermic from exposure had excellent prognoses; however, temperatures less than 26 C were associated with a marked and statistically significant incidence of death.
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The charts of 33 consecutive patients undergoing emergency department thoracotomies between July 1, 1979 and June 30, 1980 were reviewed. Thoracotomies were performed in victims of both blunt and penetrating trauma who had suffered cardiopulmonary arrest and were refractory to the usual methods of resuscitation. ⋯ There were no survivors from blunt trauma or penetrating wounds below the diaphragm. In patients with penetrating wounds above the diaphragm, emergency thoracotomy may be considerable benefit as demonstrated in our study by a 66.6% salvage rate.
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Thirty-eight emergency cricothyrotomies were performed over a 3-year period. This was the first airway control maneuver attempted in 5 patients, 3 of whom had facial and/or neck injury, one apneic with upper airway hemorrhage, and one with aortobronchial fistula. The remaining 33 procedures were performed only after other airway management failed. ⋯ Twelve of the 38 patients were long-term survivors. There was one long-term complication, a longitudinal fracture of the thyroid cartilage during forceful placement of an oversized tube (8 mm inner diameter) through the cricothyroid membrane. This required operative repair and left the patient with severe dysphonia.
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A six-bed observation ward has been an integral part of our community hospital emergency department for 10 years. During a recent 4-month period, 574 patients were admitted with 65 different clinical presentations. ⋯ Guidelines have been developed which avoid most potential pitfalls in the use of an observation ward. Significant flexibility is gained and improved patient care is possible with the addition of an observation ward to the emergency department.
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Atrial myxoma is rare. We report the case of a 54-year-old woman who presented with findings of a typical acute cerebrovascular accident, which was found to be caused by emboli from an unsuspected atrial myxoma. ⋯ Surgery was performed to remove the tumor; however, the patient remained with a left hemiparesis. The pitfalls of misdiagnosis are discussed and the need for early use of echocardiography in the work-up of stroke victims is suggested.