J Emerg Med
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Sand aspiration occurs in situations of cave-in burial and near-drowning. Sand in the tracheobronchial airways adheres to the mucosa and can cause tracheal and bronchial obstruction, which can be life-threatening even with intensive management. In previous case reports of airway obstruction caused by sand aspiration, fiber optic or rigid bronchoscopy has been effective in removing loose sand, but removal of sand particles lodged in smaller airways has proven challenging and time-consuming. ⋯ Our case of sand aspiration is unique in that the patient presents with complex medical problems (mixed respiratory and metabolic acidosis), hypothermia, hypoxemia, and neoplastic conditions. The fact that she survived the sand aspiration and a long inter-hospital transport time (90 min) with inadequate ventilation and oxygenation without apparent ill effects suggests that the measures we took to resuscitate her and extract the sand from her airways were reasonable and appropriate.
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The kidney is the third most common solid organ injury in blunt abdominal trauma. The preferred treatment of blunt kidney injury varies according to grade of severity, with a preference for non-operative management in most instances. ⋯ Our patient was managed medically despite his high grade of injury. This article reviews the diagnosis and management of blunt renal trauma and highlights the fact that despite significant injury, a patient can go on to do well with conservative management alone.
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Department of Radiology performed ultrasound for patients suspected of having intussusception in resource-limited settings might be either unavailable or significantly time delayed. ⋯ In resource-limited settings, point-of-care ultrasound performed by a physician trained to diagnose intussusception can reduce the time to definitive management and thereby potentially reduce complications such as bowel ischemia and necrosis, dehydration, and sepsis.
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It has been known for many years that interrupting chest compressions during cardiopulmonary resuscitation (CPR) from out-of-hospital cardiac arrest (OHCA) leads directly to negative outcomes. Interruptions in chest compressions occur for a variety of reasons, including provider fatigue and switching of compressors, performance of ventilations, placement of invasive airways, application of CPR devices, pulse and rhythm determinations, vascular access placement, and patient transfer to the ambulance. Despite significant resuscitation guideline changes in the last decade, several studies have shown that chest compressions are still frequently interrupted or poorly executed during OHCA resuscitations. Indeed, the American Heart Association has made great strides to improve outcomes by placing a greater emphasis on uninterrupted chest compressions. As highly trained health care providers, why do we still interrupt chest compressions? And are any of these interruptions truly necessary? ⋯ New and future technologies may provide promising results, but the greatest benefit will always be a well-directed, organized, and proactive team of providers performing excellent-quality and continuous chest compressions during CPR.