The American journal of emergency medicine
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Review Case Reports
Orthopedic pitfalls in the ED: tibial plafond fractures.
Fractures of the tibial plafond, or distal tibial articular surface, are usually associated with a high-force mechanism, which frequently can involve associated injuries and prolonged disability. Because of distracting injury and variations in clinical findings, tibial plafond fractures may be initially missed or misdiagnosed. This review examines the clinical presentation, diagnostic techniques, and management of tibial plafond fractures applicable to the emergency practitioner.
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Comparative Study
Aspiration of gastric contents: association with prehospital intubation.
We prospectively compared the incidence of pulmonary aspiration of gastric contents between patients endotracheally intubated in the prehospital (PH) setting and those intubated in the emergency department (ED). Tracheal aspirates were collected using a standard Leukens trap from all patients as soon as possible after endotracheal intubation. ⋯ The pepsin assay was positive in 10 of 20 (50%) patients intubated in the PH group, as opposed to 33 of 148 (22%) of those intubated in the ED (chi2 P=.008; odds ratio, 3.5; 95% CI, 1.34-9.08). Patients endotracheally intubated in the PH setting are more likely to have aspirated gastric contents than those intubated in the ED.
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This report presents a case of hydrochloric acid injection in the inguinal area in a suicide attempt, resulting in total occlusion of the external iliac artery, requiring disarticulation of the hip. To the authors' best knowledge, it has not been previously reported in the English medical literature. The accelerated destructive activity of these irritant chemicals and deep tissue damages are emphasized. Early and aggressive debridement with copious saline irrigation and circumspect monitoring are recommended.