J Emerg Med
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Controversial therapeutic issues in patients with caustic ingestions concern the reliability of symptoms and signs in predicting esophageal injury, the appropriate use of endoscopy in evaluating esophageal damage, and the use of steroids in preventing late strictures. The conclusions of this review are: The majority of pediatric caustic ingestions involve a "lick and taste" whereas adolescents and adults often ingest substantial quantities. ⋯ Endoscopy should be an elective rather than emergency procedure and should be undertaken in all symptomatic patients, and in asymptomatic patients when history indicates substantial ingestion. Steroid therapy should be considered only for patients who have deep or circumferential esophageal burns.
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A 39-year-old male arrived in the emergency department with multiple stab wounds to the chest. A pneumopericardium was present on initial chest x-ray study. ⋯ All parameters improved following removal of 100 cc of air by pericardiocentesis. The etiology, diagnosis, pathophysiology, and treatment of tension pneumopericardium are discussed.
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Gastric lavage or ipecac-induced emesis are routinely recommended in the management of the acutely poisoned patient. Efficacy of either procedure has not been shown. ⋯ The role of these procedures requires careful controlled evaluation. Until the publication of supportive data, their efficacy is unproven.
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Since Henry Heimlich's description of a method for relieving food choking was presented, the management of foreign body upper airway obstruction has been enveloped in controversy. The major point of contention has been the approval by the American Red Cross and American Heart Association of the chest thrust and back blows, techniques that Heimlich considered inferior and dangerous. ⋯ Most studies have found airway pressures generated by back blows to be higher than those produced by chest or abdominal thrusts. However, chest and abdominal thrusts produce their effects over a more sustained time period.
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A case of superior patellar dislocation is described. The dislocation was sustained without apparent trauma. Closed reduction was accomplished in the emergency department. No apparent injury to the patellar ligament was sustained.