The American journal of emergency medicine
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Observational Study
Chest tube insertion direction: is it always necessary to insert a chest tube posteriorly in primary trauma care?
The advanced trauma life support guidelines suggest that, in primary care, the chest tube should be placed posteriorly along the inside of the chest wall. A chest tube located in the posterior pleural cavity is of use in monitoring the volume of hemothoraces. However, posterior chest tubes have a tendency to act as nonfunctional drains for the evacuation of pneumothoraces, and additional chest tube may be required. Thus, it is not always necessary to insert chest tubes posteriorly. The purpose of this study was to determine whether posterior chest tubes are unnecessary in trauma care. ⋯ Chest tubes did not need to be directed posteriorly in many trauma cases. Posterior chest tubes have a high incidence of being malpositioned. This malpositioning may be prevented by judging the necessity for posterior insertion.
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Chest pain and/or electrocardiogram changes in non-ST elevation or suspicious chest pain and cardiac marker elevations are defined as non-ST-elevation acute coronary syndrome (NSTE-ACS). Serial electrocardiogram and marker follow-up are needed to make a diagnosis of NSTE-ACS and to eliminate noncoronary chest pain (NCCP). Signal peptide-C1r/C1s, Uegf, and Bmp1-epidermal growth factor domain-containing protein 1 (SCUBE1) is stored within the α granules of inactive platelets and secreted at a high rate during thrombosis. We believe that SCUBE1 may be a sensitive early diagnostic indicator in distinguishing coronary-induced chest pain from noncoronary-induced chest pain. ⋯ High rates of SCUBE1 were found both in the STEMI and NSTE-ACS patients. Furthermore, in the study group, SCUBE1 was an adequate marker for distinguishing NSTE-ACS from NCCP.
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Tracheobronchial injuries related to emergency endotracheal intubations are reported to be associated with an increased risk of mortality. Many mechanical risk factors may become more frequent in an emergency setting leading to such injuries. Aside from these factors that may complicate endotracheal intubation, this procedure is not recommended a priori for ventilation due to the resulting interruptions in external chest compressions, by 2010 cardiopulmonary resuscitation (CPR) and external chest compression guidelines. ⋯ Thorax computed tomography revealed an overinflated tube cuff. The trachea was repaired surgically; however, our patient died on the fourth postoperative day due to multiple-organ failure. Prehospital providers must remain especially vigilant to priorities in airway management during CPR and aware of the dangers associated with field tracheal intubation under less than ideal conditions.
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Comparative Study
Evaluation of the effectiveness of bedside point-of-care ultrasound in the diagnosis and management of distal radius fractures.
The aim of the study was to compare the effectiveness of point-of-care ultrasound (POCUS) with direct radiography in diagnosis and management of the patients with distal radius fractures (DRFs). ⋯ In our study, it was shown that POCUS could be applied easily by EPs trained in MSK POCUS imaging with success in diagnosing DRF and determining the correct fracture type and required treatment methods.
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The objective of the study is to investigate the causes of febrile illness among HIV-infected adults visiting the emergency department (ED) of a designated hospital for HIV care in Taiwan, an area of a low HIV prevalence. ⋯ The causes of febrile illness in HIV-infected adults visiting the ED varied according to CD4 count and transmission route. Two independent risk factors, intravenous drug use and skin and soft tissue infections, were associated with S aureus infections. For HIV-infected adults with lower respiratory tract infections, a CD4 lymphocyte count of less than 100 cells/mm(3) was a risk factor for P. jirovecii pneumonia.