The American journal of emergency medicine
-
To evaluate the early variations of superoxide production of neutrophils (SPN) in injured patients, SPN was serially measured on the first, third, and seventh day after severe injury (injury severity score of >16). For patients receiving subsequent surgery, SPN was measured again on the first postoperative day. Eighteen patients were studied. ⋯ Patients with EMOD also had a higher injury severity score. In conclusion, subsequent surgery after injury has no effect on the priming of neutrophils. While late priming of neutrophils in injured patients coincides with the development of sepsis, suppression of SPN is found in septic patients with EMOD that frequently results from severe injury.
-
Training programs in bedside ultrasound for emergency physicians often encounter considerable resistance, partly because of concern that the number of radiology-interpreted studies ordered from the ED may decrease. This study attempted to determine the effect of instituting an ED training program in ultrasound on the ordering of formal studies from a department of radiology. ⋯ The number of formal studies significantly increased after institution of the training program, both in terms of absolute numbers (annual mean 181 v 95, P < .001) and as a percentage of all outpatient sonograms ordered at the institution (9.8% v 5.1%, P < .001). Introduction of a teaching program in emergency ultrasound appears to increase utilization of formal ultrasound services, at least during the training period.
-
This study was conducted to evaluate the blood urea nitrogen/creatinine (BUN/Cr) ratio for distinguishing an upper versus lower source of gastrointestinal (GI) bleeding. Charts of patients who presented to the emergency department (ED) with the diagnosis of GI bleeding from August 1995 to August 1996 were retrospectively reviewed for source of bleeding, initial BUN, Cr, BUN/Cr ratio, hematocrit (Hct), and need for transfusion. A total of 124 patients were eligible for inclusion, 71 (57%) of whom were male. ⋯ Upper GI bleeding was significantly correlated with age younger than 50 (P = .01) and male gender (P = .01; odds ratio, 3.13). Taking into account age and gender, the BUN/Cr ratio correlated significantly with an upper GI source of bleeding (P = .03), with a ratio greater than 36 having a sensitivity of 90% and a specificity of 27%. The area under the receiver operating characteristic curve using age, gender, and BUN/Cr ratio was .73 (95% confidence interval, .62 to .84).
-
A prospective, consecutive study was performed to determine if medical student supervision in the emergency department (ED) changes patient throughput time (ie, the time from triage to discharge). The mean patient throughput time on days when medical students were present in the ED (group 1) was compared to the mean patient throughput time on days when medical students were absent from the ED (group 2). Throughput time was measured in minutes. ⋯ The two groups were also compared for mean daily acuity (as gauged by mean daily number of patient admissions) and mean daily patient census. The differences in mean daily throughput times (group 1, 145.2 min v group II, 150.6 min; P = .40), mean daily census (group 1, 28.1 patients v group 2, 28.1 patients; P = .75), and mean daily admissions (group 1, 10.4 patients v group 2, 10.7 patients; P = .74) were all insignificant. Precepting medical students in this ED did not significantly change patient throughput times.
-
Case Reports
Congenital diaphragmatic hernia with gastric volvulus presenting as an acute tension gastrothorax.
This report describes a 3-month-old infant with acute severe respiratory distress in whom a diagnosis of congenital diaphragmatic hernia with tension gastrothorax and gastric volvulus was made. A review of the pathophysiology, clinical presentation, differential diagnosis, diagnostic evaluation, and treatment of congenital diaphragmatic hernia is presented.