Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To determine the safety of percutaneous central venous access when used for trauma resuscitation and whether the initial hemodynamic status of the patient or the site of placement affects the ease or success of line placement. ⋯ Percutaneous central venous access is relatively safe and reliable for gaining intravenous access when resuscitating trauma patients, when used in a center where physicians are experienced in the technique. Consideration should be given to expanding the use of central venous access in trauma resuscitation.
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Air embolism produced by vaginal insufflation is an unusual but potentially lethal consequence of sexual activity, especially in the pregnant patient. Reported here is the case of a young pregnant woman who presented to the ED in full cardiac arrest, with little history to explain her condition. ⋯ Air embolism patients may require vigorous medical resuscitation, hyperbaric oxygen therapy, or surgical intervention to survive. The emergency physician should be familiar with the indications for perimortem cesarean delivery in the third-trimester patient presenting to the ED with cardiac arrest.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparative study of the percutaneous versus intraoral technique for mental nerve block.
Mental nerve block is frequently used to aid repair of facial lacerations; both percutaneous and intraoral approaches to blocking this nerve are used, but have never been compared. The authors compared the two techniques for pain of administration and effectiveness of anesthesia. ⋯ The intraoral approach to the mental nerve block with adjunctive topical anesthesia was subjectively and objectively less painful than the percutaneous approach without adjunctive anesthesia. While the intraoral approach had a greater efficacy of lower-lip anesthesia and a longer duration of action, these differences were not statistically significant.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intraoral and percutaneous approaches for infraorbital nerve block.
The infraorbital nerve block is frequently used during repair of facial lacerations; both percutaneous and intraoral approaches are used. The authors compared the two techniques for pain of administration and anesthetic effectiveness. ⋯ The intraoral approach to the infraorbital nerve block after adjunctive topical anesthesia appeared at least as effective in producing upper-lip anesthesia as the percutaneous approach without adjunctive topical anesthesia. Although the volunteers subjectively preferred the intraoral approach and visual-analog pain scores were lower for this approach, these differences did not achieve statistical significance. The intraoral approach was associated with a longer duration of upper-lip anesthesia.