The American journal of emergency medicine
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The variable and nonspecific presentations of psoas abscess, as well as its infrequent incidence in the emergency department (ED), can result in delayed diagnosis or misdiagnosis. Previous reports have not discussed the diagnostic difficulties of psoas abscess from the viewpoint of emergency physicians (EPs), especially in light of the widespread use of ED ultrasonography. This report describes a 1-year experience between November 1993 and October 1994, during which 10 ED patients were diagnosed to have psoas abscess; in 7 cases, diagnoses were established in the ED. ⋯ With their alertness and their expertise in ultrasonographic techniques, EPs can make an immediate diagnosis and arrange an early drainage procedure. For patients with sepsis of unknown origin, prolonged fever of unknown origin, and some specific manifestations suggestive of psoas abscess, the screening ultrasound should scan not only abdominal solid organs but also peritoneal cavity and retroperitoneal space. In addition, a flow chart is presented for facilitating the diagnosis of psoas abscess in the ED.
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Hospital pharmacies in Massachusetts were surveyed to determine their patterns of stocking antidotes. Mailed questionnaires were completed by hospital pharmacy directors at 82 of 93 acute care institutions (87% response rate). Results confirmed great variability in on-site accessibility of antidotes. ⋯ We conclude that Massachusetts hospitals do not carry complete inventories of 14 common antidotes. It is important that poisoned patients be referred to medical centers with adequate toxicological care. Improved guidelines for the accessibility of antidotes need to be developed and made available to hospital pharmacies and emergency departments.
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Establishing central intravenous access in the emergency department (ED) is often both crucial and difficult. In patients with nonexistant or ambiguous external anatomic landmarks, a real-time ultrasound guided approach to internal jugular vein cannulation is useful. ⋯ The use of ultrasound for establishing central venous access has never been described in an ED setting. Two such cases in which ultrasound was extremely helpful for establishing central access in an ED are reported, the techniques employed for real-time ultrasound guidance of internal jugular vein catheterization are described, and the literature that supports the use of this technique is reviewed.
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Nasal foreign bodies requiring removal occur commonly in young children. Different techniques of removal are needed depending on the type of nasal foreign body. A retrospective chart review of a 19-month period identified 60 pediatric patients with nasal foreign bodies evaluated in a pediatric emergency department. ⋯ Most foreign bodies can be managed with simple equipment and without requiring otolaryngology consultation. Because of the many different nasal foreign bodies found, the physician should be skilled in numerous techniques of removal. Each one of these useful techniques is reviewed.
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Blood-borne pathogens threaten all individuals involved in emergency health care. Despite recommendations by the Centers for Disease Control and the American College of Emergency Physicians, documented compliance with universal precautions in trauma resuscitation has been poor. The purpose of this study was to determine the factors that predispose to noncompliance with barrier precautions at a level I trauma center. ⋯ Barrier precaution compliance improved from 62.5% to 91.8% with prenotification of patient arrival. Immediate access to barrier equipment is essential for all potential in-hospital first responders. Prehospital communication systems should be optimized to ensure prenotification.