J Emerg Med
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A 28-year-old woman presented to the emergency department for treatment of a corneal abrasion. Shortly after inserting two drops of proparacaine hydrochloride eye drops into her conjunctival sac, she experienced a tonic-clonic seizure. The absorption, systemic effects, and side effects of topical ophthalmological preparations are discussed.
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Intravenous fluid therapy is a mainstay in the treatment of trauma and hypovolemia. However, controversy exists as to its effective use by prehospital personnel. We reasoned that 12-gauge catheters, shown to have significantly greater fluid flow than 14- or 16-gauge catheters, might allow prehospital care providers to have a more significant role in patient resuscitation. ⋯ The catheters were placed under normal field conditions. Per preexisting protocols, departure from the scene and transport to the hospital were not delayed for any paramedic interventions, including starting intravenous lines. The 12-gauge catheters can be successfully used by paramedics, both to establish large bore intravenous access prior to arrival at the emergency department and to institute effective fluid therapy where time and circumstances allow.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ventilation performance: standard resuscitation bag and the resuscitation bag controller.
Clinical evaluation of ventilation performance during resuscitation is largely subjective. A mechanical device, the resuscitation bag controller (RC), which encircles the bag and allows controlled compression may improve the precision and accuracy of ventilation with manual resuscitation bags (MRB). We hypothesize that more precise, controlled pressure ventilation can be delivered with the RC, compared to the MRB. ⋯ PAPS were less than or equal to 30 cm H2O for 93% of all breaths. Hospital personnel delivered a significantly greater percent of inadequate (less than 0.8 L) breaths, 19 versus 7.4%, and excessive pressure breaths, 9.2 versus 4.2%, when compared to prehospital personnel. We conclude that the resuscitation bag controller offers little advantage over standard bag resuscitation for adult resuscitation.(ABSTRACT TRUNCATED AT 250 WORDS)
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In this third article in a continuing series on objectives for emergency medicine training, orthopedic objectives are presented. Orthopedic complaints are common in emergency medicine. Direction in mastering evaluative, cognitive, and procedural skills are provided utilizing behaviorally based objectives and references. These objectives provide a structure for systematically learning the content of orthopedics through enlightened patient care, questioning of attending physicians and supervisors, and directed reading.
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Three patients are described who developed either pneumomediastinum or "clicking pneumothorax" after abusing illicit drugs. In recent years, patients presenting with pneumomediastinum after abusing cocaine have been frequently reported; these patients are most commonly young males with pleuritic chest pain. Seventy-three percent have detectable subcutaneous emphysema and fifty percent have a Hamman's sign. The pathophysiology, presenting features, and treatment of patients with barotrauma related to inhalational drug abuse are reviewed.