The American journal of emergency medicine
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A 22-year-old previously healthy male was admitted to the emergency department for chest pain and dyspnea of 1-day's duration. He had a history of heavy smoking. The patient was cyanotic, agitated, and severely dyspneic. ⋯ Simultaneous bilateral spontaneous pneumothorax was diagnosed from the chest x-ray, and chest tube drainage was immediately performed bilaterally. Computerized tomography of the chest 1 month later showed diffuse emphysematous bullae of the lungs. The case presented here should increase physicians' awareness of this rare form of spontaneous pneumothorax and its diverse manifestations.
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One hundred twelve patients presenting with a Glascow Coma Scale (GCS) score greater than or equal to 13 with a history of minor head trauma were prospectively studied to determine if certain historic or physical examination variables would predict which of these patients were at increased risk for intracranial injury. Patients either underwent cranial computed axial tomography (CT) or were followed up by phone at 4 weeks to determine major morbidity or mortality. Thirty-five patients underwent CT scanning of the head and eight demonstrated intracranial injury. ⋯ All eight patients with positive CTs had a GCS score of 15. The authors conclude that intracranial injury does exist in patients suffering minor head trauma with a GCS score of 13 or above. Age over 40 years and complaint of headache are associated with an increased risk of intracranial injury.
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During an 18-month period the authors followed 1,024 patients referred to a general medical intensive care unit. A total of 7% of these patients underwent emergency surgery at some point during their admission. The role of abdominal ultrasound in the decision-making process for these emergency surgical interventions was evaluated and the patients were identified for whom the pathologic result of sonography was regarded sufficient to operate without any additional imaging procedures. ⋯ In all cases the sonographic diagnosis was confirmed during the operation. The critical care patients most likely to benefit from bedside ultrasound in a surgical emergency were those with hemorrhage of unknown origin (44%) or septicemia from an undetected focus (39%). The most frequent site of operation where ultrasound was considered diagnostic was the urinary tract (56%), particularly in emergencies following renal transplantation.
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The authors describe a potential application of ultrasound in detection of pills in the stomach, and report the first case of its use in a patient. Thirty pills were studied in vitro by ultrasound. All were clearly detected, with better imaging compared with plain radiography. ⋯ A sustained-release phenytoin capsule was detected by ultrasound in the stomach of a patient 3 hours after its ingestion. Ultrasound is a potential diagnostic tool in detection of pills in the stomach following acute ingestion. Its use, however, seems to be limited to sustained-release or enteric-coated preparations.
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The American Heart Association no longer recommends the routine use of sodium bicarbonate in cardiac arrests. Reasons cited include the lack of documented effect on clinical outcome and potential adverse effects of metabolic alkalosis and hypernatremia. We reviewed 36 months of experience with 619 nontrauma adult, prehospital cardiac arrest patients to identify 273 successful resuscitations who had emergency department blood gases and electrolytes performed. ⋯ No patients in the NO HCO3 group had hypernatremia (sodium [Na]+ greater than 150), whereas four patients (2%) in the HCO3 group were hypernatremic. Eight patients (14%) in the NO HCO3 group and 37 patients (17%) in the HCO3 group were alkalotic with pH values greater than 7.49 (P = NS). Six patients (10%) of the NO HCO3 group and 24 patients (11%) of the HCO3 group had a metabolic component to the alkalosis as defined by a positive base excess value (P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)