The American journal of emergency medicine
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The study objectives were to examine the differences between Peak Expiratory Flow (PEF) formulae in the literature and to assess the potential impact of those differences on the interpretation of clinical guidelines for asthma management. We calculated 100% PEF values for hypothetical patients at the 50(th) percentile for height and weight and classified the percent predicted PEF into severity groups according to national asthma guidelines. ⋯ Predicted PEF varied widely across formulae and choice of formula may alter guideline-based care. We propose recently published population-based equations as the reference standard for future asthma guidelines.
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Review Case Reports
Bedside emergency ultrasonographic diagnosis of diaphragmatic rupture in blunt abdominal trauma.
Abdominal injury from significant blunt trauma can include injury to bowel, kidneys, liver, and spleen. In approximately 5% of all injuries one of the diaphragms is ruptured. Diaphragmatic rupture may not be easily detected and this can lead to significant morbidity and even mortality. ⋯ Although not typically part of the basic Focused Abdominal Sonography for Trauma (FAST) examination, ultrasonographic diagnosis of diaphragmatic rupture is possible with little added time to the examination. We present 3 cases of diaphragmatic rupture discovered shortly after the patients' arrival, on initial trauma evaluation with the FAST. A discussion of previous literature and ultrasound technique for diagnosis follows the cases.
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Fractures of the calcaneus are usually associated with a high-force mechanism, which frequently can involve associated injuries and prolonged disability. Due to distracting injury and variations in clinical findings, calcaneal fractures may be initially missed or misdiagnosed. This review article examines the clinical presentation, diagnostic techniques, and management of calcaneal fractures applicable to the emergency practitioner.
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Comparative Study
Prolonged gastric emptying half-time and gastric hypomotility after drug overdose.
A prospective study was undertaken to determine if gastric motility and emptying are altered by the ingestion of overdoses of tricyclic antidepressants, acetaminophen, opioid-acetaminophen mixtures, carbamazepine or phenytoin. Gastric scintigraphy was used to measure gastric emptying half-time and assess gastric motility in 104 patients at initial presentation and again at follow-up (n = 85). Patients were imaged for 5 hours after being given 20 MBq of 99mTc tin colloid to drink. ⋯ Twelve patients had gastric emptying half-times of over 300 minutes, a further 14 had half-times of over 200 minutes and 21 others had half-times of over 120 minutes. Poisoning is associated with hypomotility and a marked delay in gastric emptying that could influence the clinical course and patient management. These abnormalities may not be due to a direct effect of the ingested drug and factors such as stress may play a role.
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Review Case Reports
An uncommon life-threatening complication after chest tube drainage of pneumothorax in the ED.
Re-expansion pulmonary oedema (REPO) after chest tube drainage of pneumothorax is uncommon. We contrast one patient with life threatening against another mildly symptomatic REPO occurring in our emergency department (ED). The mechanism and management of REPO differs distinctly from that of cardiogenic pulmonary oedema. We discuss the predictors of REPO, review clinical details of reported fatalities and suggest preventive measures.