The American journal of emergency medicine
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Airway control is the initial priority in the management of the injured patient. The purpose of this investigation was to evaluate the experience of an aeromedical transport team in the utilization of rapid sequence induction (RSI) for endotracheal intubation in the prehospital setting. Records of a consecutive series of injured patients undergoing RSI between June 1988 and July 1992 by a university-based aeromedical transport team were reviewed for demographics, intubation mishaps, and pulmonary complications. ⋯ Failure to intubate occurred in three patients (4%). Performed under strict protocol by appropriately trained aeromedical transport personnel, RSI is an effective means to facilitate endotracheal intubation in the injured patient requiring definitive airway control. Pulmonary complications were related to injury severity and not to intubation mishaps.
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A pooled analysis was conducted of the seven studies on the clinical diagnostic effectiveness of the Ottawa ankle rules when used with adult patients in the emergency department (ED). The seven studies, conducted in university and community hospital EDs, had examined the sensitivity, specificity, and positive and negative predictive values of the Ottawa ankle rules. ED physicians applied the Ottawa ankle rules with adult patients who had blunt ankle injuries. ⋯ Thus, the Ottawa ankle rules should not be used for ruling in a fractured ankle or foot. This pooled analysis shows the Ottawa ankle rules to be effective as clinical practice guidelines for acute ankle and foot injuries in the adult ED patient. Patients with negative results when the rules are used are highly unlikely to have a fractured ankle or foot, but the diagnosis for positive patients is much less certain, suggesting the need for radiography.
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Review Case Reports
Fatal colchicine overdose: report of a case and review of the literature.
Colchicine poisoning is an uncommon, but potentially life-threatening, toxicologic emergency. A case is reported of a 21-year-old woman who presented to the emergency department approximately 1 hour after ingesting 30 mg of colchicine in a suicide attempt. ⋯ Despite aggressive medical management, the patient suffered a cardiac arrest and died 8 days after the ingestion. The clinical features of colchicine poisoning are highlighted and current therapeutic options are discussed.
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Immediate cardiac arrest may occur as a result of the physiological consequences of critical airway management, which may include one or all of the following: (1) sedation and/or paralysis, (2) tracheal intubation, and (3) positive pressure ventilation. Two patients are reported, both with myocarditis, who developed cardiac arrest within minutes of simple intubations. Their arrests were not related to technical difficulties of critical airway management. ⋯ This may be a significant mechanism through which immediate decompensation occurs. Potential conditions that cause preload-dependent cardiovascular systems, as well as alternate therapeutic considerations, are outlined. In these patients intubations should not be delayed, but should be done with extreme caution in anticipation of possible cardiac arrest.
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To describe the chronotoxicology of cocaine and its potential impact on emergency department (ED) staffing and services, Drug Abuse Warning Network (DAWN) data from a single urban university ED were retrospectively reviewed. The DAWN data reviewed spanned an 11-year period (1/1/83 through 12/31/93), and 3,762 patients were enrolled. Patients were included if the ED records included documentation of recent cocaine abuse prior to presentation to the ED. ⋯ For all patients using cocaine, there were two significant rhythms (P < .05) identified: a circadian rhythm that peaked at 1800 and a 12-hour rhythm that peaked at approximately noon and midnight. A significant rhythmicity was found among cocaine-using patients who presented during the study period. Increased or shift-adjusted staffing focusing specifically on psychosocial services, detoxification, and security during these peak hours may provide more efficient emergent care for this subpopulation of patients.