J Emerg Med
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Case Reports Randomized Controlled Trial
Pediatric self-inflating resuscitators: the dangers of improper setup.
Self-inflating resuscitators (SIRs) are often used in pediatric resuscitation. Improper setup of the SIR can lead to inadequate ventilation and oxygenation. ⋯ In a normal lung, the volumes delivered by SIRs are significantly decreased with the pop-off valve and manometer port open. Proper set-up of the SIR becomes even more important when lung compliance is poor.
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Trauma to the foot and ankle from inversion injury accounts for a considerable number of Emergency Department (ED) visits. Acute subtalar dislocations are rare injuries most commonly caused by high-velocity mechanisms that can produce long-term complications if not reduced promptly. The subtleties of the dislocation on plain films can be easily overlooked in a fast-paced environment like the ED, especially if the patient presents with an atypical mechanism. ⋯ Although medial subtalar dislocations are an uncommon injury, they usually can be reduced easily in the ED, achieving a good long-term prognosis with appropriate follow-up. The findings on plain film X-rays can be subtle at times, and the dislocation may not always present with a classic history of high-velocity trauma.
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Although the issues concerning the impact of emergency department (ED) overcrowding have been the subject of much recent concern, there are few data regarding the effect of ED census on emergency physician behavior with respect to the decision to admit patients. Admission rates might either increase or decrease on busy days, when the system and the physician are under stress. ⋯ The likelihood of a patient's admission vs. discharge is not affected by ED patient volume. Furthermore, we found no evidence that an individual physician's admitting behavior was associated with ED patient volume.
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Patients are encouraged to complete limitation-of-medical-treatment forms (LMTFs), sometimes referred to as code status forms or do-not-resuscitate forms, before admission to hospitals or other health care facilities in the United States. ⋯ Our findings demonstrate that there is no standardization across LMTFs currently used in hospitals throughout the United States, and these forms are written above the literacy level of the average American adult. Therefore, there is a need to develop and disseminate an LMTF that is both consistent and better understood by the average American adult.
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Case Reports
Glass foreign body in soft tissue: possibility of high morbidity due to delayed migration.
Soft tissue foreign bodies (FBs) are a common occurrence in emergency departments (EDs). Some FBs cause complications, whereas others are asymptomatic and remain undetected for months or years. ⋯ Retained soft-tissue foreign bodies may migrate very late and can cause high morbidity or mortality. It is important to be diligent in the search for foreign bodies, using ultrasound, computed tomography scan, or magnetic resonance imaging in cases in which initial plain radiographs are negative.