J Emerg Med
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Blunt carotid artery trauma represents only 3% of all carotid artery injuries, but 42% of reported cases have been associated with severe neurologic deficits. We present a case of blunt injury to the right internal carotid artery with subsequent thrombosis and neurologic deficit. ⋯ We review the incidence, mechanism, presentation, and treatment of blunt carotid injuries. We also stress the importance of observing for blunt carotid injuries in the patient with blunt cervical trauma in order to allow earlier intervention, since patient outcome is dependent on that early recognition and intervention.
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Case Reports
Massive ethylene glycol poisoning without evidence of crystalluria: a case for early intervention.
A case of severe ethylene glycol poisoning is presented, characterized by protracted delirium, coma, and delayed adult respiratory distress syndrome. This patient never demonstrated evidence of calcium oxalate crystalluria or renal insufficiency. ⋯ Early empiric ethanol therapy and consideration of dialysis are recommended for those patients with such a presentation without evidence of abnormal levels of ketones, lactate, salicylate, or ethanol. It is proposed that early ethanol therapy may prevent the formation of ethylene glycol metabolites to the extent that calcium oxalate crystalluria is not seen.
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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)