The American journal of emergency medicine
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Blood-borne pathogens threaten all individuals involved in emergency health care. Despite recommendations by the Centers for Disease Control and the American College of Emergency Physicians, documented compliance with universal precautions in trauma resuscitation has been poor. The purpose of this study was to determine the factors that predispose to noncompliance with barrier precautions at a level I trauma center. ⋯ Barrier precaution compliance improved from 62.5% to 91.8% with prenotification of patient arrival. Immediate access to barrier equipment is essential for all potential in-hospital first responders. Prehospital communication systems should be optimized to ensure prenotification.
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Uterine incarceration is a rare complication of pregnancy, usually presenting between 12 and 20 weeks' gestation, when the gravid uterus normally ascends through the pelvic brim. Conditions such as pelvic inflammatory disease, endometriosis, postoperative adhesions, posterior wall leiomyomas, and pelvic contraction may lead to fixed retroflexion of the uterus, predisposing to this condition. A case of incarceration is presented. Clinical features, diagnosis, treatment, and potential complications are discussed.
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Pluronic F68 was selected as the gel carrier for antimicrobial agents because of its extensive use as a wound cleanser in humans without discernable side effects. When the concentration of this surfactant is increased to 46%, it forms a water soluble gel that can serve as a carrier for antimicrobial agents. ⋯ In experimental animals, this stable gel carrier containing 0.2% nitrofurazone significantly reduces the bacterial concentration of Staphylococcus aureus in wounds to a greater degree than silver sulfadiazine. This antimicrobial gel has the same antimicrobial activity as polyethylene glycol carriers containing 0.2% nitrofurazone, but does not carry the potential risk of polyethylene glycol intoxication.
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To evaluate cricothyroidotomy in the field and the influence of physicians' medical specialty or previous experience on the success rate of this procedure, a retrospective study was conducted. Between October 1991 and April 1995, 29 cricothyroidotomies were performed in the prehospital setting in Israel. Twenty-six (89.6%) cricothyroidotomies were successfully performed. ⋯ All physicians had successfully completed the Advanced Trauma Life Support (ATLS) course, but only three had previously performed cricothyroidotomy. Acute complications included failure to establish an airway in 3 cases, minor bleeding in 2 cases, and an air leak around the cannula in 1 patient. These results show that following brief training (eg, the ATLS course) physicians are capable of performing emergency cricothyroidotomy in the field with a high success rate and minimal complications, regardless of medical specialty.
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A computer program (the Audit Assistant) was developed to help physicians review the care of critically ill emergency department (ED) patients. The program is an example of a new class of decision aids that serves to remind physicians to consider possibilities, not an artificial intelligence program that actually attempts to simulate clinical reasoning. The goal of such programs is to enable physicians to reduce errors--in this case to enable reviewers to notice more of the errors in care in the cases they are reviewing. ⋯ All reviewers preferred the Audit Assistant-suggested list to the critical action list generated by a previous reviewer not using the Audit Assistant (P < .02). Use of the Audit Assistant improved the completeness and the consistency of physician review of mock charts of critically ill ED patients in a small series of cases. The critical actions added for review were important, as demonstrated by the preferential addition of critical actions chosen by other reviewers who were not using the computer program.