The American journal of emergency medicine
-
To assess how soon rural emergency departments (EDs) call for helicopters to transport seriously injured patients, the records of all trauma victims (excluding isolated CNS trauma) transported by an emergency helicopter service from referring hospitals to a trauma center over an 18-month period were studied. Admission time to the referring ED was compared with the exact time a call for the helicopter was received and a time-to-request interval (TTR) was calculated. A total of 64 cases were studied. ⋯ Children (aged less than or equal to 16 years) had an average TTR of 34.1 minutes compared with 76.4 minutes for adults (aged greater than 16 years). Of the variables examined, patient age was the only factor significantly associated with TTR. These observations suggest that, except in children, there frequently is a lengthy time interval between the time trauma patients arrive at EDs in rural eastern North Carolina and the time an emergency helicopter service is called to transport them to a trauma center.
-
Three cases representing the emergency department use of pulse oximetry are described. A brief review of the principles of operation of pulse oximetry, as well as a discussion of recent literature and clinical uses of the technology, is presented. While not replacing arterial blood gases in the assessment of critically ill patients, a more widespread use of pulse oximetry in evaluating emergency department patients might provide significant information in the management of patients with respiratory complaints. Pulse oximetry may also play an important role in monitoring those patients requiring airway interventions such as assisted ventilation or endotracheal intubation.
-
Envenomation by the North American coral snake is an uncommon entity in the United States. In most cases fang marks will be present, although they may be quite small and difficult to see. The case of a young man who demonstrated evidence of envenomation following the bite of a Texas coral snake (Micrurus fulvius tenere), despite the absence of any apparent fang marks on close examination, is reported. The problems associated with coral snake envenomation in terms of diagnosis and management are reviewed.
-
Since the introduction of sulfonamides in the late 1930s, coalescent mastoiditis is an uncommon complication of otitis media. Swelling, erythema, and tenderness over the mastoid area with associated anterior displacement of the auricle are classic signs and symptoms of coalescent mastoiditis with formation of a subperiosteal abscess. ⋯ Prompt otolaryngologic consultation is indicated and inpatient antibiotic therapy should be begun. Surgical treatment is also needed and may obviate further complications.
-
A 42-year-old woman was hospitalized with aspirin intoxication. The patient developed massive skeletal muscle damage without any evidence of muscle compression, hyperthermia, or other predisposing factors. The exact mechanism by which salicylates cause muscle damage is unknown, but the muscle damage appears to be the result of a direct toxic effect. This represents the first case of isolated salicylate-induced rhabdomyolysis.