The American journal of emergency medicine
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The objective of this study was to review indications for retrograde endotracheal intubation (REI) and to examine outcomes and complications associated with this technique. We reviewed all intubations of adult emergency department patients over an 8-year period. A total of 1681 charts were reviewed with 313 excluded because of inadequate documentation of intubation. ⋯ Complications included inability to locate the cricothyroid membrane (n=2), inability to pass the endotracheal tube through the vocal cords (n=1), and procedure time of more than 3 minutes (n=4). Retrograde endotracheal intubation was successful in securing the airway in 4 cases and unsuccessful in 4 cases. We found that although REI was attempted for trauma and non-trauma-related respiratory compromise, it was associated with multiple complications, and successful in only 4 of 8 cases.
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Case Reports
The electrocardiographic toxidrome: the ECG presentation of hydrofluoric acid ingestion.
The clinician can approach the poisoned patient using the toxidrome system of toxin identification; this approach makes use of findings noted on the physical examination, highlighting the importance of abnormalities in blood pressure, heart rate, respiratory effort, body temperature, mental status, pupillary size, skin color, diaphoresis, and gastrointestinal sounds. Such a method provides structure and guidance to the clinical evaluation, providing the clinician with rapid diagnostic information and suggesting urgent management issues. ⋯ The constellation of these findings suggested the possibility of a caustic agent (history and examination) with potential effect on potassium and calcium metabolism (electrocardiographic abnormalities). Such a constellation strongly suggested hydrofluoric acid as the culprit toxin.
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Letter Case Reports
Isolated extrahepatic bile duct rupture in blunt abdominal trauma.