J Emerg Med
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Despite recent efforts to apply a public health epidemiology to violence in America, most physicians do not incorporate violence prevention methodologies into their own individual practices. The challenge of integrating violence detection, prevention, and management into the delivery of health care begins by building on the recent successful implementation of injury prevention and control policies. Three specific issues that physicians can address in their individual practice settings are reviewed: 1) alcohol and substance abuse, 2) firearms, and 3) family violence. This article focuses on these issues and addresses the concept of the physician as an advocate for change.
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We investigated how patients were evacuated and transported from affected hospitals in the disaster area to backup hospitals following the 1995 catastrophic Hanshin-Awaji earthquake. A retrospective review was conducted of medical records of 6107 patients hospitalized during the first 15 days after the earthquake, collected from 48 affected hospitals in the disaster area and 47 backup hospitals in the surrounding area. Of the 6107 patients, a total of 2290 (38%) were transferred to backup hospitals, consisting of 187 patients (50%) with crush syndrome, 702 (26%) with other traumas, and 1401 (41%) with illness. ⋯ The mortality rate for patients with trauma and crush syndrome was significantly higher in the affected hospitals. These results suggest that the existing emergency medical service system was not adequate for this urban earthquake. From our vantage point, we are keenly aware of the need for improved communications between hospitals, a well equipped patient transport system, and a well coordinated disaster response mechanism.
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"Locked" or dislocated temporomandibular joint (TMJ) is a common problem in emergency medicine. Like many other joint dislocations, the repositioning of the joint can be facilitated by conscious sedation and muscular relaxation. ⋯ We report two cases of locked TMJ that were repositioned under sedation with propofol. We review methods for repositioning the locked TMJ and review appropriate agents for sedation and muscular relaxation.
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Emergency physicians commonly manage patients with acute respiratory failure who require assisted mechanical ventilation. Several different modes of positive pressure mechanical ventilation can be used to manage these patients when they present to the emergency department. ⋯ A comprehensive review of the most important historical moments in mechanical ventilation as well as the different modes commonly used in the emergency department are presented. In addition, new techniques in noninvasive mechanical ventilation are presented.