J Emerg Med
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Criteria for excluding cervical spine injury in patients who have sustained blunt head or neck trauma were prospectively studied at four hospitals in the Chicago area. The authors attempted to define a subset of these adult patients who, based on clinical criteria, could reliably be excluded from cervical spine radiography, thus avoiding unnecessary radiation and saving considerable time and money in their evaluation. ⋯ Patients with central neck pain or tenderness (group 3) had significantly more fractures (7/237) than patients without pain or tenderness or with these findings limited to the trapezius area (0/236). It is clear that patients who have altered mental status, abnormal examination findings, distracting injury, or pain or tenderness over the cervical spine must have cervical spine radiographs.(ABSTRACT TRUNCATED AT 250 WORDS)
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Traditionally, treatment in the emergency department is noted for brief doctor-patient encounters, fragmented service, and lack of follow-up care. This atmosphere can lead to patient dissatisfaction and may contribute to the high rate of noncompliance with discharge instructions and medications. To cope with this problem, a prospective study was designed to evaluate a telephone follow-up system and its effect on patient care and satisfaction. ⋯ Of the patients contacted 42% (97/229) required further clarification of their discharge instructions. The calls resulted in direct medical intervention in the majority of patients (6/7) who stated their clinical condition had worsened. Ninety-five percent of the patients questioned (112/118) felt that the call was useful.(ABSTRACT TRUNCATED AT 250 WORDS)
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The airway management of 176 consecutive traumatized patients aeromedically transported from the scene of injury was reviewed. In particular, the frequency of performance and time requirements for both blind nasotracheal intubation and cricothyrotomy were analyzed. Airway control was attempted in 70 (39.5%) patients and successful in 67 (95.7%). ⋯ The remaining three patients were nasotracheally intubated in the emergency department. Neuromuscular blockade was not used in either setting. Despite the difference in patient acuity, there was no statistically significant difference in scene or transport times between those patients emergently intubated and those who were not (P greater than .05).
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The rapid and safe establishment and maintenance of an adequate airway in patients with acute, severe head injuries is of central importance in the "ABC" approach to the trauma victim. It is also necessary before hyperventilation can be instituted as a means of controlling intracranial pressure. A method of establishing an airway in a manner that best protects the patient from unnecessary elevations in intracranial pressure with the least possible risk is presented. This method can be applied in virtually all emergency departments, from community hospitals to teaching centers, using materials and expertise currently available.