J Emerg Med
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Community emergency physicians (EPs) are often required to respond to unstable patients outside of their department during off-hours. ⋯ Many community EPs are responsible for covering critically ill patients outside of their ED. Further investigation is required to determine the impact on patient care.
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Pandemic influenza A (H1N1) has emerged rapidly in Argentina since May 2009. Preliminary comparisons with seasonal influenza suggest that H1N1 disproportionately affects younger patients, generally causing mild disease, but in a minority of cases can be lethal. ⋯ Within the context of an influenza epidemic with the new H1N1 virus, the use of two simple and accessible clinical signs permits a rapid differentiation between those patients requiring close monitoring vs. those with mild and self-resolving disease.
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Case Reports
Massive subcutaneous emphysema and pneumomediastineum after finger subtotal amputation with barotrauma.
Advancement of pressurized air through subcutaneous tissue after barotraumas involving skin laceration has been documented in the literature. The type and anatomic location of injury, amount of pressure, and time elapsed all play a role in determining the destination of the air advancing through tissues. ⋯ Compressed air injuries constitute a well-known form of industrial accident. Although most result in localized subcutaneous emphysema, the risk of pneumomediastinum should not be overlooked due to the anatomic structure of the vascular system. The clinician should consider the pressure of compressed air, and must be alert for potential complications.
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Patient-physician interactions in the emergency department (ED) are unique in that prior relationships may not exist; interactions are brief, and the environment is hectic. ⋯ Patient satisfaction scores are not associated with increased risk management episodes but are closely related to receiving complaints. Receiving complaints is a strong marker for increased risk management episodes and should prompt early corrective action.