J Emerg Med
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Thirty-seven critical emergency department patients underwent attempts at external cardiac pacing over an 11-month period. Indications for pacing were asystole in 16, complete heart block (CHB) in 4, sinus bradycardia in 2, nodal bradycardia in 1, atrial fibrillation with bradycardia in 2, electromechanical dissociation in 1, idioventricular rhythm (IVR) in 10, and torsades de pointes in 1. Eight patients were successfully paced with improvement in their condition. ⋯ External cardiac pacemaking appears to be effective in hemodynamically significant bradycardia. It does not appear to be effective in most instances of asystole or IVR resulting from prolonged cardiac arrest. When applied to patients with a responsive myocardium, it may result in significant hemodynamic improvement and may be lifesaving.
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Biography Historical Article
Ivan Magill: forceps for intratracheal anesthesia.
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Codeine often causes gastrointestinal cramping and pain. Treatment for such symptoms is usually symptomatic and supportive. ⋯ The authors present four cases in which naloxone (Narcan) was used with success in relieving gastrointestinal side effects that were apparently due to codeine. It is suggested that patients with gastrointestinal symptoms and a history that strongly implicates codeine as the etiology be treated with naloxone.
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Case Reports
Free intraperitoneal cholelithiasis--a sign of traumatic perforation of the gallbladder.
Traumatic perforation of the gallbladder is relatively infrequent and is rare as an isolated lesion. The unique aspect of this case is the diagnosis of traumatic gallbladder perforation based on plain abdominal roentgenographic evidence of free intraperitoneal cholelithiasis.
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The incidence of abnormalities in 1,869 sets of radiographs was recorded, and the accuracy of the interpretation of these films by emergency physicians was assessed. Abnormalities were most frequent in hip/femur (52.5%), thoracic spine (46.7%), and shoulder (44.8%) films and least frequent in skull (5.7%), cervical spine (14.9%), and foot (15.7%) films. The accuracy of interpretation by emergency physicians for all categories of films was 93.6%, with 1.8% false positives and 4.6% false negatives. ⋯ The incidence of missing existing pathology was highest for abdomen (40.0%) and knee (31.6%) films. The overall accuracy of the emergency physicians in interpretation of emergency films was excellent. Increased didactics in particular areas of interpretive inaccuracies should be considered.