The American journal of emergency medicine
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Case Reports
Cricothyroidotomy on the scene in a patient with severe facial trauma and difficult neck anatomy.
We present a case of a patient with severe facial trauma who was treated at the scene by a physician-staffed trauma life support team. Because of massive oropharyngeal bleeding in addition to a difficult neck anatomy in a very obese patient, a cannot-intubate, cannot-ventilate situation occurred. Control of the airway could finally be achieved by surgical cricothyroidotomy. The current literature concerning emergency cricothyroidotomy is discussed.
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It has been observed that emergency department (ED) attendances are not random events but rather have definite time patterns and trends that can be observed historically. ⋯ We found definite and consistent patterns of patient demand and designed a rostering tool to match ED manpower demand.
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Comparative Study
An observational, prospective study comparing tibial and humeral intraosseous access using the EZ-IO.
Intraosseous (IO) access is an alternative to conventional intravenous access. The proximal tibia and proximal humerus have been proposed as suitable sites for IO access. ⋯ Both sites had high-insertion success rates. Flow rates were significantly faster with a pressure bag infusion than without. However, we did not find any significant difference in tibial or humeral flow rates.
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Ethylene glycol poisoning is a medical emergency. Making a definitive diagnosis is challenging because few institutions have timely access to direct measurement of ethylene glycol. ⋯ We present the case of a 47-year-old male patient initially admitted to the intensive care unit for severe lactate acidosis of unknown cause (pH 6.96, lactate, 30 mmol/L). Knowledge of potent artifactual lactate results was the key to the diagnosis of ethylene glycol poisoning, and false lactate measurements were found at the central laboratory on our 3 different blood gas analyzers.
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Identification of congestive heart failure via respiratory variation of inferior vena cava diameter.
Rapid diagnosis of volume overload in patients with suspected congestive heart failure (CHF) is necessary for the timely administration of therapeutic agents. We sought to use the measurement of respiratory variation of inferior vena cava (IVC) diameter as a diagnostic tool for identification of CHF in patients presenting with acute dyspnea. ⋯ Inferior vena cava ultrasound is a rapid, reliable means for identification of CHF in the acutely dyspneic patient.