J Emerg Med
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The physical properties of lightning are given, including a description of the different observed lightning forms. The wide variety of effects of lightning on humans is reviewed. ⋯ Recommendations for emergency department evaluation, treatment, and disposition are given. Guidelines to prevent humans from being struck by lightning are discussed.
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Comparative Study
The role of an emergency department observation unit in the management of trauma patients.
During a 12-month period, 20,838 patients with acute traumatic injuries were seen in the Emergency Department (ED) of Denver General Hospital. Of these patients, 520 (2.5%) were admitted to the ED Observation Unit, a seven-bed acute care unit situated within the ED and sufficient data were available on 485 (93%) for inclusion into the study. Fifty-three (15.4%) of these observation unit patients required subsequent admission, 389 (80%) were discharged, and 16 (4%) left against medical advice. ⋯ These groups of patients were analyzed and compared with regard to severity of injury, length of stay, and discharge diagnosis. The observation unit is useful in the evaluation of blunt chest or abdominal trauma when work-up, including chest x-ray studies and peritoneal lavage, is initially negative and when drug or alcohol ingestion obscures the initial evaluation in the ED. An observation unit within the ED is cost-efficient and has proven very useful in the management of trauma victims.
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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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Cricothyrostomy is the procedure of choice for emergency airway control when nasotracheal and endotracheal intubation are not possible or contraindicated. A vertical skin incision followed by a horizontal incision in the cricothyroid membrane are used. A number 6 tracheostomy tube should be used due to the anatomic size of the cricothyroid space. Using this technique, complications are rare.
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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.