The American journal of emergency medicine
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A prevertebral soft tissue measurement exceeding 4 to 5 mm at C3 on a lateral spine radiograph is considered to be evidence of cervical spine injury. The objective of this study was to determine the sensitivity of the prevertebral soft tissue measurement at C3 in patients with proven cervical spine fractures or dislocations and to determine if this measurement correlates with the location or mechanism of injury. Consecutive patients 16 years of age or older who were admitted from July 1988 to June 1995 to a tertiary referral hospital with a discharge diagnosis of cervical spine fracture or dislocation were retrospectively studied. ⋯ For anterior (n = 95) and posterior (n = 70) injuries the sensitivities were 64% (95% CI 54, 74) and 64% (95% CI 52, 75), respectively. There was no statistically significant difference in the prevertebral soft tissue measurement at C3 for high versus low injury, anterior versus posterior injury, or mechanism of injury. These results show that the prevertebral soft tissue measurement at C3 is an insensitive marker of cervical spine fracture or dislocation and does not correlate with the location or mechanism of injury.
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A prospective, descriptive study is reported on the use and success of ultrasound-assisted internal jugular central vein catheterization (CVC) in the emergency department (ED). In patients not in cardiac arrest who had an indication for internal jugular CVC, lines were placed by trained ED staff using ultrasound. Data were collected prospectively on age, sex, body habitus, indication, vein visibility, number of punctures and needle passes, and success. ⋯ In 8 patients with no visual or palpable landmarks, cannulation was successful in 100% (7 of 7) using ultrasound and in 0% (0 of 1) using landmark technique. Ultrasound-assisted internal jugular CVC is an easily learned technique that is useful in the ED. It may be especially helpful in patients in whom landmarks are not visible and not palpable.
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A study was undertaken to determine the criteria for ordering abdominal computed tomography (CT) in the emergency department (ED) for stable patients who sustained blunt trauma and to identify a patient population at high risk for having intra-abdominal injury (IAI) utilizing physical examination, decrease in hematocrit, and hematuria. Patients in a university ED who had abdominal CT from April 1995 to October 1995 were evaluated prospectively. Before the scan, the examining physician completed an entry form that included physical findings, hematocrit, hematuria, Glasgow Coma Scale score, intoxication, distracting injuries, reasons for obtaining the scan, and planned disposition. ⋯ These results show that early CT scanning of stable patients who have sustained blunt trauma is an effective screen for IAI and may result in fewer total admissions, but has potential for overuse. Patients with abdominal pain and hematuria should be scanned. The benefit of a CT scan for patients without tenderness or with an isolated decrease in hematocrit is questionable.
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Comparative Study
Comparison of normal saline with tap water for wound irrigation.
This study compared irrigation with tap water versus saline for removing bacteria from simple skin lacerations. The study was conducted in an animal model with a randomized, nonblinded crossover design using 10 500-g laboratory rats. Two full-thickness skin lacerations were made on each animal and inoculated with standardized concentrations of Staphylococcus aureus broth. ⋯ One tap water specimen had markedly aberrant bacterial counts compared with others. Excluding this specimen, the mean reduction for tap water was 80.2%. In this model, reduction in bacterial contamination of simple lacerations was not different comparing tap water with normal saline as an irrigant.
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This study was undertaken to determine the time interval for changes in end-tidal CO2, oxygen saturation (SaO2), heart rate (HR), and blood pressure (BP) in response to an acute airway obstruction or hypopharyngeal extubation in a hyperoxemic model. Complete and partial airway obstructions were simulated with complete and partial cross-clamping of an endotracheal (ET) tube in five anesthetized, nonparalyzed, mechanically ventilated Yorkshire minipigs with initial PAo2 of > 400 mm Hg. Placement of the ET tube into the hypopharynx was performed to simulate accidental extubation. ⋯ Hypopharyngeal extubation produced a flattening of the SS and MS waveform in 7 +/- 1 seconds and 7 +/- 2 seconds, respectively. The SS and MS monitors displayed zero in 18 +/- 3 seconds and 76 +/- 16 seconds, respectively. Continuous end-tidal CO2 capnography detects acute airway obstruction and hypopharyngeal extubation more rapidly than does pulse oximetry or vital sign monitoring in a hyperoxemic porcine model.