The American journal of emergency medicine
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A case of cardiac arrest following hypothermia due to cold-water immersion is presented. Following rescue and initiation of cardiopulmonary resuscitation, the patient was transported by helicopter to a facility where rewarming using cardiopulmonary bypass was possible. Initial rectal temperature in the emergency department was 28 degrees C. ⋯ Temperature at the time of cardioversion was 30 degrees C (esophageal). Despite extended cardiac arrest and profound metabolic acidosis (pH = 6.41 at 37 degrees C), he recovered uneventfully and is neurologically normal. A protocol for the management of a patient with hypothermic cardiac arrest is included.
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The clinical management of 12 patients with major intrathoracic tracheobronchial rupture (complete, 3; incomplete, 9) due to blunt trauma has been reviewed and compared with that of two groups of patients with chest injuries not involving the tracheobronchial tree, 17 patients with multiple rib fractures and 17 with chest injuries requiring thoracotomy for control of pneumothorax and hemothorax. The effect of injury on ventilatory function was significantly greater in the patients with tracheobronchial injury in whom an elevated PCO2 at the time of admission was associated with a poor prognosis. Conventional ventilatory management with endotracheal intubation and positive pressure ventilation causing increased air leakage produced further deterioration of pulmonary function in four of the patients with tracheobronchial disruption. The use of a double-lumen endobronchial tube in two patients with tracheobronchial rupture facilitated ventilatory support and subsequent operative management.
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The developing countries of the world represent a new environment in which to apply the unique expertise and knowledge of emergency medicine. With an understanding of the cultural, political and economic forces that affect health care in developing countries, American emergency physicians should consider collaboration with their counterparts in developing countries in such areas as prehospital care systems, trauma care, disaster management, poison information and management systems, and education related to clinical services, administration, and research methods in emergency medicine. Such collaboration can broaden the field of emergency medicine and fulfill individual humanitarian goals.
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Review Case Reports
Emergency department management of retained rectal foreign bodies.
A plastic toothbrush case was removed from the rectum of a prison inmate in the emergency department using a rigid sigmoidoscope and a fogarty catheter. The patient was subsequently discharged from the emergency department. Previous literature regarding rectal foreign bodies has emphasized inpatient treatment and tended to ignore the potential value of the emergency service. Guidelines for selecting appropriate patients for emergency department management are presented and basic principles for safe outpatient removal are reviewed.