The American journal of emergency medicine
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Clinical Trial Controlled Clinical Trial
Carbon monoxide poisoning while using a small cooking stove in a tent.
Carbon monoxide (CO) is formed wherever incomplete combustion of carbonaceous products occurs.(1) CO is the leading cause of poisoning in the United States, and common sources of CO poisoning include housefires, automobile exhaust, water heaters, kerosene space heaters, and furnaces.(2) Stoves used for cooking and heating during outdoor activities also produce significant amounts of CO. Mountain climbers have been reported to succumb to fumes generated by small cook stoves.(3) The aim of this study was to investigate if burning a cooking stove inside a tent is a potential health hazard. Seven healthy male volunteers used a cooking stove inside a small tent for 120 minutes. ⋯ Mean SpO2, also fell from 98% to 95.3% (P <.05), whereas mean HR increased from 63 to 90 beats/min (P <.05). Kerosene camping stoves do produce CO when burned in a small tent. The concentration is high enough to cause significant COHb levels in venous blood after 120 minutes' stay in the tent.
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Comparative Study
Comparison of EPs' and psychiatrists' laboratory assessment of psychiatric patients.
EPs frequently transfer psychiatric patients to psychiatric hospitals with the approval and acceptance of a psychiatrist. EPs and psychiatrists have an unknown set of testing routines and requirements that are used to determine medical clearance of the psychiatric patient. The purpose of this study was to compare the routine and required testing performed by EPs as compared with psychiatrists. ⋯ It is unknown if the psychiatrists influenced the ordering behavior of the EPs. However, this study does demonstrate a difference in the routine test ordering, implying that these is a difference in the approach to the patient in the ED. Further means to obtain congruence in the testing protocol of psychiatric patients would be a valuable endeavor.
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The objectives of this study were to review variable factors influencing outcomes in hanging and to identify prognostic factors related to outcomes. Forty-seven patients presented to our department. Eleven patients survived and 36 died. ⋯ In survivors, eight patients had a GCS greater than 3. A significant difference in outcome existed between patients with a GCS of 3 and those with a GCS greater than 3. Hanging time, presence of CPA at the scene and on arrival, and GCS on arrival represented prognostic factors of outcome in hanging.
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To determine the incidence of toluidine blue positive findings after speculum examination of sexual assault victims, we performed a prospective before and after study of 27 female patients presenting after sexual assault to a free-standing nurse examiner clinic. Before the insertion of a speculum, a 1% aqueous solution of toluidine blue was applied to the posterior fourchette and photographs were taken using colposcopy with digital imaging (16 x magnification). After the forensic examination was completed, dye was reapplied. ⋯ Before speculum examination, genital injuries from sexual assault were documented in 67% of the patients (mean number of genital injuries, 1.4). After speculum examination, one patient (3.7%) demonstrated a new genital injury-an abrasion to the labia. Until further studies are performed, use of a speculum should be delayed until after toluidine dye application.