J Emerg Med
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We evaluated unpredictable critical conditions of patients treated in the Emergency Department (ED) observation unit, who were transferred into the emergency resuscitation room from January 1 through June 30, 2001. A total of 175 patients were observed for the following critical conditions: dyspnea (51 patients; 29.14%), hypotension (28; 16.00%), chest pain (18; 10.29%), dysrhythmia (15; 8.57%), hematemesis (15; 8.57%), altered mental status (12; 6.85%), shock (10; 5.71%), coma (8; 4.57%), apnea (5; 2.86%), hematochezia (3; 1.72%), seizure (3; 1.72%), and others (7; 4.00%). The 27 patients who had cardiopulmonary resuscitation (CPR), endotracheal tube intubation, or cardioversion/defibrillation in the ED suffered an in-ED mortality of 25.9% (7) and an in-hospital mortality of 59.2% (16). ⋯ We should limit the number of patients in the observation unit to avoid overloading, and classify patients according to their clinical conditions. We should determine whether or not they have definite diagnoses or are waiting for hospital admission while receiving simple treatments. The observation unit must be provided with well-trained staff and suitable physical facilities with support services, and rapid specialty consultations must be available.
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Temporomandibular joint (TMJ) dislocation is an infrequent dislocation of the mandible. The usual technique of reduction, recommended by most Emergency Medicine textbooks, consists of downward forces applied to the mandible. ⋯ We present a patient in whom the usual manner of TMJ dislocation reduction was difficult. We describe a novel technique for TMJ dislocation reduction that uses the intrinsic biomechanical properties of the mandible.
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To assess the pre-study, null hypothesis that there is no difference in the electrocardiogram (EKG) findings for Emergency Department (ED) patients who rule in vs. rule out for suspected pulmonary embolism, a retrospective review of a cohort of patients with pulmonary embolism and their controls was conducted in an academic, suburban ED. Patients who were evaluated in the ED during a one-year study period for symptoms suggestive of pulmonary embolism were eligible for inclusion. All patients with pulmonary embolism and sex- and age-matched controls comprised the final study groups. ⋯ Abnormalities believed to be associated with pulmonary embolism occurred with similar frequency in both case and control groups (sinus tachycardia [18.8 % vs. 11.8%, respectively; p = 0.40]), incomplete right bundle branch block (4.2% vs. 0.0%, respectively; p = 0.24), complete right bundle branch block (4.2% vs. 6.0, respectively; p = 1.0), S1Q3T3 pattern (2.1 vs. 0.0, respectively; p = 0.49), S1Q3 pattern (0.0 vs. 0.0), and extreme right axis (0.0 vs. 0.0). New EKG changes were identified more frequently for patients with pulmonary embolism (33.3% vs. 12.5% controls; p = 0.03), but specific findings were rarely different between cases and controls. In our cohort of ED patients, we did not identify EKG features that are likely to help distinguish patients with pulmonary embolism from those who rule out for the disease.
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We sought to describe the common causes of infection in patients presenting to the Emergency Department (ED) with elevated temperature and chemotherapy-induced neutropenia and to determine the frequency with which the ED diagnosis of infection is consistent with the final hospital discharge diagnosis. We performed a structured restrospective chart review of ED patients with fever (T > 38 degrees C) and neutropenia (absolute neutrophil count < 1000/mm(3)) over a 2-year period. Fifty-five episodes of neutropenic fever occurred in 52 patients (mean age 52 years, range 18-86 years; 53% men). ⋯ The 29 patients without a source identified in the ED were hospitalized and had negative blood and urine cultures and were discharged to home after resolution of fever. A thorough history, physical examination, chest radiograph and urinalysis in the ED identified all patients with a focus of infection. Meticulous ED evaluation of patients with neutropenia and fever may be sufficient to diagnose most sources of infection; however, a significant number of patients without an identifiable focus may have bacteremia.