The American journal of emergency medicine
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With regionalization of specialized health care services, some patients must be transferred between hospital to receive needed care. The authors evaluated 100 transfers to their emergency department as to the adequacy of stabilization prior to transport. Problems were identified in the areas of communication (nine cases), oxygenation (two cases), cardiac monitoring (one case), intravenous lines (eight cases), airway (two cases), ventilation (one case), equipment and personnel accompanying the patient (one case), bladder catheterization (four cases), nasogastric suctioning (one case), radiographs (nine cases), and spinal immobilization (seven cases). ⋯ A review of the literature shows that inadequacies in stabilization for transfer are widespread. This may be improved through physician education, use of transport teams, and judicious use of interhospital transport. The indications and responsibilities of transfer are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Transcutaneous electrical nerve stimulation versus oral analgesic: a randomized double-blind controlled study in acute traumatic pain.
A double-blind controlled analgesic study was undertaken in outpatients suffering acute traumatic pain. One hundred patients completed the study and were randomly assigned to four treatment groups, each receiving either functioning transcutaneous electrical nerve stimulators (TENS), placebo TENS, acetaminophen with codeine and a functioning TENS, or acetaminophen with codeine and a placebo TENS. ⋯ The TENS was approximately as effective as acetaminophen (300-600 mg) with codeine (30-60 mg) but had no side effects. Transcutaneous electrical nerve stimulators have been shown to be effective in the management of acute traumatic pain and may be indicated for patients who cannot be given medications.
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As the use of helicopters for air transport of critically ill patients increases, the availability of monitoring devices for physiological parameters during flight becomes important. It has long been known that arterial PO2 (PaO2) decreases during unsupplemented, non-pressurized flight. In this study, the authors examined the use of the transconjunctival oxygen (cjO2) monitor for assessing the adequacy of arterial oxygenation during helicopter flight in four healthy volunteers. ⋯ The relationship between cjO2 and PaO2 was linear with a regression coefficient of 1.147. The authors conclude that the transconjunctival O2 monitor may be useful for monitoring the adequacy of arterial oxygenation during helicopter flight in hemodynamically stable patients. The results of study also support the use of supplemental oxygen in all patients subjected to helicopter transport.
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An 80-year-old man was treated, non-operatively, for a distal esophageal perforation, diagnosed nine days after blunt thoracic trauma. Emergency department diagnosis was impeded by absence of mediastinal air; right chest-wall emphysema was thought to result from associated rib fractures. ⋯ This mode of therapy may be best in comparable elderly patients with esophageal perforation that is overlooked during the initial 24 hours after injury. Possibly, routine barium swallow in all patients with chest-wall emphysema and rib fractures would circumvent missed esophageal rupture after blunt trauma.
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An unusual case of a misdirected nasogastric tube is described. An elderly woman was brought to an emergency department following intentional drug overdose. Initially unrecognized errant placement of a large-bore nasogastric tube resulted in tension pneumothorax, pneumonia, and subsequent death. Pertinent medical literature is reviewed, clinical considerations for the elderly patient are discussed, and suggestions for proper nasogastric tube placement are offered.