The American journal of emergency medicine
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Case Reports
Water bath evaluation technique for emergency ultrasound of painful superficial structures.
Researchers have described the use of bedside emergency ultrasound as an effective way to evaluate for and accurately drain potential abscesses. Similarly, descriptions exist of long bone fracture evaluation in the wrist and hands. Tendon injury can also be detected with ultrasound and exploration can be obviated or at least focused. ⋯ We describe 7 cases in which, despite aggressive attempts at pain control, adequate evaluation of extremity pathology was not possible without the use of the water bath technique. Patients reported no discomfort and superior quality images were obtained due to the water bath properties. Emergency sonologists should keep this technique in mind when contact between skin and the ultrasound transducer is likely to cause a patient significant discomfort.
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Case Reports
Control of massive bleeding from facial gunshot wound with a compact elastic adhesive compression dressing.
The issue of immediate control of acute external traumatic hemorrhage is poorly dealt with in the medical literature. A compact unit incorporating the desired components capable of applying significant compression over diverse body areas has been suggested in the past but not formally demonstrated effective in practice. In this report we describe the treatment of a young man presenting with a very large, complex, profusely bleeding facial gunshot wound. ⋯ We attribute the survival of this victim to the innovative dressing technique and excellent cooperation between the trauma team and hospital staff. This case demonstrates the contribution of elastic adhesive compression dressing towards saving the lives of those inflicted by severely challenging bleeding wounds. We suggest this technique be considered by Emergency personnel working in the prehospital arena in selected cases.
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Infections and severe sepsis in solid-organ transplant patients admitted from a university-based ED.
The objective was to provide a descriptive analysis of infectious processes in transplant patients admitted from the emergency department (ED). A database of all adult transplant patients at a university medical center was cross-referenced with a computerized record of all ED visits over an 18-month period. ED charts, inpatient records, and microbiology data were retrospectively reviewed. ⋯ Nine of 77 patients (11.7%) with documented infections developed severe sepsis, which was the most common reason for ICU utilization. Thirty-five percent of transplant patients admitted from the ED had acute infections, and 11.7% of these patients had severe sepsis. The emergency physician must have a high index of suspicion for infections when evaluating organ transplant recipients.