J Emerg Med
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Comparative Study
Pressurization of i.v. bags: a new configuration and evaluation for use.
External pressure devices are often utilized to increase the flow rates of IV fluids in exsanguinating patients. However, increasing the flow rate by this method also increases the rate at which IV bags need changing. Time is lost and valuable personnel are preoccupied in maintaining the numerous hand-pumped external pressure devices and IV bags. ⋯ A new multiunit configuration (Infusor-Rack) for the pneumatic device is also described. We found a significant decrease in IV bag take-down/setup time with the new pneumatic pressure device. This system is faster, more reliable, and easier to use than the standard hand-pumped pressure bag and should be viewed as a practical improvement in the fluid delivery system.
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The effective teaching of clinical emergency medicine to medical students requires efficiency in the management of both student and faculty time. Presented is a course outline that makes use of the following elements to structure and augment clinical time in the emergency department (ED): Videotape to present a 19.7-hour series of faculty-produced lectures covering a "core" emergency medicine curriculum. A microcomputer to facilitate staggered scheduling of clinical time. ⋯ Once established, this program can be administered with fewer than five faculty hours per month assisted by a part-time (25% full-time equivalent) clerical coordinator. The total cost for the instructional program is $86.37 per student using the new technologies, and $144.15 per student when presenting the same program using traditional teaching techniques. The use of new technologies in student teaching will therefore result in significant savings.
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Superficial abscesses are commonly seen in the emergency department. In most cases, they can be adequately treated by the emergency physician without hospital admission. Treatment consists of surgical drainage with the addition of antibiotics in selected cases. ⋯ Staphylococcus aureus accounts for less than half of all cutaneous abscesses. Anaerobic bacteria are common etiologic agents in the perineum and account for the majority of all cutaneous abscesses. Abscesses at specific locations involve special consideration for diagnosis and treatment and may require specialty consultation.
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Near-drowning is defined as survival for at least some period of time after suffocation from submersion in a liquid. This article is a comprehensive review of the demography, pathophysiology, treatment, and prevention of near-drowning, an accident that affects approximately 6,000 to 7,000 Americans per year. Forty percent of these victims are children younger than 5 years. ⋯ The hypothermic patient requires special considerations. The role of aggressive cerebral resuscitation has not been elucidated. Prevention of the circumstances that lead to near-drowning must be stressed as a public service.
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Since Henry Heimlich's description of a method for relieving food choking was presented, the management of foreign body upper airway obstruction has been enveloped in controversy. The major point of contention has been the approval by the American Red Cross and American Heart Association of the chest thrust and back blows, techniques that Heimlich considered inferior and dangerous. ⋯ Most studies have found airway pressures generated by back blows to be higher than those produced by chest or abdominal thrusts. However, chest and abdominal thrusts produce their effects over a more sustained time period.