J Emerg Med
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The purpose of this experimental study was to compare the effect of a tissue adhesive, N-butyl-2-cyanoacrylate, on the wound's ability to resist infection and gain strength to the effect of percutaneous polypropylene suture. Percutaneous sutures damaged host defenses, inviting the growth of bacteria to a level that was significantly greater than that encountered with the tissue adhesive. ⋯ Seven days later, the breaking strengths of wounds closed by tissue adhesives did not differ significantly from those repaired with percutaneous sutures. Tissue adhesive closure requires less psychomotor skills than suture closure and is accomplished more rapidly than suture closure.
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A case of pneumoscrotum after a suicide jump with blunt chest trauma and chest tube placement is reported. Pneumoscrotum itself has little clinical importance, but it is essential for the clinician to determine the origin of the air, and a careful search for the source of air is necessary. Three possible routes of air in the pneumoscrotum are reviewed. Many reported cases, including this case, had a cause distant from the pelvis: air dissected subcutaneously to the scrotum because of pneumothorax, tube thoracostomy, and air leak combined with ventilatory resuscitation efforts.
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Compartment syndrome is a serious potential complication of trauma to the extremities. Fractures, crush injuries, burns, and arterial injuries, among others, can result in increased tissue pressure within closed osseofascial or compartmental spaces. Prolonged exposure to elevated pressure can result in nerve and muscle necrosis. ⋯ Compartment syndrome is a surgical emergency requiring prompt treatment by fasciotomy. Time is a critical factor; the longer the duration of elevated tissue pressure, the greater the potential for disastrous sequelae. Emergency medicine providers must be cognizant of this clinical syndrome so that early emergent surgical consultation can be obtained to avoid complications.
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The incidence of true scaphoid fracture and the value of radionuclide scan was evaluated in a 1-year retrospective review of 54 emergency department patients with a preliminary diagnosis of clinical scaphoid fracture (snuff box tenderness and negative initial X-ray study). All emergency department charts of patients with a discharge diagnosis of clinical scaphoid fracture were reviewed to determine the number ultimately found to have a true scaphoid fracture and to ascertain how the diagnosis was actually achieved. All patients were managed by immobilization in a thumb spica cast for a period of 10-14 d, with repeat clinical assessment and radiographs at that time. ⋯ In addition, a bone scan revealed the presence of two previously unsuspected fractures (one distal radius fracture and one triquetral fracture) in two patients with continued clinical tenderness. This study confirms the previously reported low incidence of scaphoid fractures in patients with a diagnosis of clinical scaphoid fracture. It also demonstrates the importance of technetium bone scan as a diagnostic tool of increased sensitivity, as compared to traditional radiographs, in detecting the presence of scaphoid fractures and in detecting other clinically unsuspected fractures in this group of patients.
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This article is the second of two parts outlining the objectives for a resident rotation in cardiology. Cardiology is offered as an off service rotation or an elective at some emergency medicine residency training programs. ⋯ We have developed a written core curriculum containing a subject content list, learning objectives, and references for emergency medicine residents on cardiology services. This is a continuation of a series of objectives for off-service rotations for emergency medicine residents.