The American journal of emergency medicine
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Clinical Trial Controlled Clinical Trial
Antibiotic prophylaxis in intraoral wounds.
This study of 100 patients was undertaken to determine the efficacy of penicillin/erythromycin prophylaxis in the management of intraoral lacerations in the pediatric population. Only six patients of the evaluable population developed infections (6.4%). Two of these patients received antibiotic prophylaxis (4%), and the other four were control patients (8%) who developed wound infections (P = 0.41). ⋯ Cross-product ratios for these small sample subgroups indicated that the likelihood of infection for non-prophylactically treated patient wounds of greater than 1 cm length and/or those requiring suturing was two to three times higher than that of patients treated prophylactically. Although no statistical significance could be ascribed to the observed differences of these post hoc categories, benefit from antibiotic prophylaxis may have been quantifiable in a study designed to assess only these major wounds utilizing a large sample size. In general, routine antibiotic prophylaxis appears unwarranted for simple intraoral lacerations in children, although it may be useful when the wounds are large enough to be sutured.
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A case of massive degloving injury of the trunk, with open pelvic fracture, and evisceration of abdominal contents from blunt trauma is presented. The most significant aspect of this case was the transfusion of 173 units of packed cells and 176 units of fresh frozen plasma in the first thirty hours. The patient ultimately recovered and returned to work.
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The case of a man who injected turpentine intravenously in an attempt to kill himself is reported. The patient developed immediate pulmonary edema and hypoxia, followed later by cellulitis at the site of injection. Although only one death to date has been attributed to this form of chemical abuse, extensive local reactions, pulmonary involvement, central nervous system depression, and febrile reactions should be anticipated, and such patients should be admitted to the hospital. Patients should be observed for local reactions and myonecrosis around the site of injection, especially as these occur 12-24 hours later.
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The case records of 39 patients with classic (non-exertional) heatstroke presenting to an urban emergency department were reviewed. Eight of 39 patients died. ⋯ The rate of mortality in the rapid cooling group was four of 27 (15%), while in the delayed cooling group, the mortality rate was four of 12 (33%) (P = 0.18). Factors such as advanced age, hypotension, altered coagulation status, and the necessity for endotracheal intubation on presentation dictated a poor outcome despite successful cooling measures.
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The two new uses for the nasopharyngeal airway include facilitation of nasogastric intubation and nasotracheal intubation. First this technique takes advantage of the nasopharyngeal airway's unique ability to traverse the nasopharynx atraumatically and serve as a conduit for the smaller nasogastric tube. This technique also utilizes the nasopharyngeal airway to dilate the nasopharyngeal passage atraumatically, thus facilitating the passage of an endotracheal tube during nasotracheal intubation.