The American journal of emergency medicine
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Letter Case Reports
Nitroglycerin in the treatment of the serotonin syndrome.
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Comparative Study
Comparison of sexual assaults by strangers versus known assailants in a community-based population.
The medical literature has generally supported the view that sexual assaults by strangers are more serious and more violent than assaults by people known to the victims. This retrospective study was conducted to compare characteristics of sexual assaults by strangers and those by people known to the victims in a community-based population of women. Study patients were consecutive female patients, age 13 years or older, presenting to a sexual assault clinic during a 40-month study period. ⋯ Sexual assault by a stranger was more likely to occur in the home of the victim (43% v 28%, P < .001), involve weapons or physical coercion (58% v 31%, P < .001), and was associated with more non-genital injuries (61% v 40%, P < .001). However, the overall frequency of anogenital trauma (77% v 71%, P = .10), the mean number of anogenital injuries (2.0 v 2.3, P = .05), and the types of genital trauma were similar in both groups of women. These results demonstrated that 71% of the victims of acquaintance rape sustain anogenital trauma and that these injuries may be as extensive as those caused by unknown assailants.
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A difficult to intubate patient occurs infrequently in the emergency department. The endotracheal tube introducer or gum elastic bougie is a device used by British anesthesiologists in difficult airways. The device is inexpensive, has few complications and is easy to use. Similar to the Seldinger technique for gaining access to a large central vein, the endotracheal tube introducer is used to assist in cannulating the trachea and acts like the wire in central vein access.
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We are submitting a case-based presentation illustrating medical errors in the use of epinephrine for the treatment of anaphylaxis. Readers will learn from mistakes made by other emergency caregivers in treating anaphylaxis. The article will specifically review the recommended use of epinephrine in the management of anaphylaxis. ⋯ In the remaining 2 cases, epinephrine use was either omitted or significantly delayed in its administration. Our presentation includes a review of consensus statements regarding the treatment of anaphylaxis with particular regard to the use of epinephrine. We hope that this information will help prevent similar errors from harming other patients.
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This study's purpose was to identify risk factors for return and admission within 72 hours of discharge from the emergency department (ED). During a 2-year period, 104,584 patients were seen and discharged in the ED, and 493 (0.47%) patients returned within 72 hours requiring admission. Risk factors compared were age, sex, race, insurance status, and initial diagnosis. ⋯ The highest risk initial diagnosis categories were mental disorder (1.2%), genitourinary system (0.93%), and symptom-based diagnoses (0.76%). Also, a high proportion of patients arrived by ambulance. Patients at increased risk of early admission can be identified and should be the first target for prospective prevention strategies that seek to minimize high-risk early returns to the ED.