The American journal of emergency medicine
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To evaluate the rate of patient compliance with follow-up ultrasound (US) examinations 5 to 7 days after emergency physician EP performed US exams to rule out lower extremity deep venous thrombosis (DVT) in the ED. ⋯ Patients who were instructed to obtain follow-up lower extremity US examinations to rule out propagation of unseen, distal DVTs did so at a very low rate in our study. One of the largest impediments in our study population was a patients' primary care physician who may not understand the need for a follow-up US examination.
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Critically ill children often require endotracheal intubation before and during interhospital transport. Accurate placement and maintenance of the endotracheal tube (ETT) is crucial. The new Pediatric Advanced Life Support guidelines require confirmation of proper ETT position immediately after intubation and during transport by capnography or end-tidal carbon dioxide (ETco(2)) detection in all children with a perfusing rhythm. Currently, there are no practical alternatives for monitoring ETco(2) during pediatric transport. Therefore, we evaluated NPB-75, a quantitative handheld microstream capnometer, during transport of children to our urban children's hospital. ⋯ This lightweight microstream capnometer with a 4-hour battery life and audiovisual alarms functioned well in the prehospital setting. It provided both quantitative and graphic real-time detection of ETco(2) in intubated patients, which was of critical importance for the optimal management of patients during transport.
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Shoulder dislocations are often associated with significant pain, and many emergency physicians choose conscious sedation to achieve reduction. Concerns about oxygenation, airway protection, and aspiration may make some patients poor candidates for conscious sedation. Ideally, complete pain control and muscle relaxation could be achieved without airway compromise. ⋯ Recent work has shown that ultrasound guidance is ideal for the interscalene block and would make it possible in the ED. We present 4 cases of patients receiving ultrasound-guided interscalene blocks for pain control and muscle relaxation during shoulder reduction. Complete pain control, muscle relaxation, and joint reduction were achieved in each case.