1/64. The portable Doppler: practical applications in EMS care.The practical application of a new, commercially available, portable Doppler ultrasound device to the operation of a busy city-county emergency department and ambulance service was investigated. An initial evaluation using healthy volunteers confirmed accuracy and reproducibility of the Doppler blood pressure readings comparable to that of auscultatory and palpatory measurement. In selected patients, the Doppler readings correlated well with readings from patients who had intra-arterial lines. When used in several low flow states, such as testing adequacy of cardiopulmonary resuscitation (CPR) and verification of electromechanical dissociation, the Doppler aided the clinical evaluation and treatment in many cases where traditional methods were useless. The Doppler was also helpful in the evaluation of local arterial injury but this unit was not found sensitive enough for venous disease. Finally, the Doppler enhanced the obtaining of vital signs in the noisy environment of our ambulances.- - - - - - - - - - ranking = 1keywords = health (Clic here for more details about this article) |
2/64. Traumatic fracture of the hyoid bone: three case presentations of cardiorespiratory compromise secondary to missed diagnosis.hyoid bone fractures secondary to blunt trauma other than strangulation are rare (ML Bagnoli et al., J Oral Maxillofac Surg 1988; 46: 326-8), accounting for only 0.002 per cent of all fractures. The world literature reports only 21 cases. Surgical intervention involves airway management, treatment of associated pharyngeal perforations, and management of painful symptomatology. The importance of hyoid fracture, however, rests not with the rarity of it, but with the lethal potential of missed diagnosis. We submit three cases with varying presentations and management strategies. All three of our cases incurred injury by blunt trauma to the anterior neck. Two patients required emergent surgical airway after unsuccessful attempts at endotracheal intubation. One patient presented without respiratory distress and was managed conservatively. After fracture, the occult compressive forces of hematoma formation and soft tissue swelling may compromise airway patency. It is our clinical observation that hypoxia develops rapidly and without warning, leading to cardiorespiratory collapse. With endotracheal intubation prohibited by obstruction, a surgical airway must be established and maintained. Recognition of subtle clinical and physical findings are critical to the diagnosis of laryngotracheal complex injuries and may be life-saving in many instances. To ensure a positive outcome, a strong degree of suspicion based on mechanism of injury is mandated.- - - - - - - - - - ranking = 0.0079012345679012keywords = world (Clic here for more details about this article) |
3/64. Emergency correction of coagulation for mitral valve replacement in an orally anticoagulated 17-year-old patient with pronounced hepatic dysfunction.A 17-year-old patient with Shone's disease had to be readmitted to the hospital 3 months after implantation of an artificial aortic valve because of extreme mitral insufficiency with consecutive pulmonary edema and hepatic dysfunction. He had been orally anticoagulated and presented with a high international normalized ratio of 6.7. Emergency replacement of the mitral valve was possible only after administration of prothrombin-complex concentrate, as vitamin k(1) and fresh frozen plasma did not correct the hemostatic defect sufficiently.- - - - - - - - - - ranking = 1.0309232664259keywords = international (Clic here for more details about this article) |
4/64. myocardial infarction associated with phenylpropanolamine.phenylpropanolamine is a sympathomimetic agent widely used in over-the-counter and prescription decongestant medications. We describe a young woman without cardiac risk factors who sustained myocardial infarction after unintentional overuse of a nasal decongestant containing phenylpropanolamine. The pathophysiology of myocardial injury and current management strategies as related to this agent are discussed. Although serious adverse reactions to phenylpropanolamine are uncommon, potentially serious harm may be caused by this widely available drug in healthy individuals.- - - - - - - - - - ranking = 1keywords = health (Clic here for more details about this article) |
5/64. Viral myocarditis presenting with seizure and electrocardiographic findings of acute myocardial infarction in a 14-month-old child.Acute viral myocarditis is an uncommon but potentially fatal illness in children. patients with myocarditis may present with nonspecific symptoms or atypical findings that make diagnosis in the emergency department difficult. We describe a previously healthy 14-month-old child with difficulty breathing and a tonic-clonic seizure who was subsequently found to have ECG changes and cardiac marker elevation consistent with acute myocardial infarction. The patient was immediately transferred from our community hospital ED to our tertiary care children's hospital. Shortly after admission, the patient developed intractable nonperfusing ventricular arrhythmias necessitating extracorporeal membrane oxygenation. Cardiac function did not recover, and the patient required heart transplantation before cessation of bypass. serology and anatomic pathology confirmed coxsackievirus B myocarditis. This case illustrates (1) the nonspecific presentation of myocarditis as dyspnea and seizure, (2) the manner in which myocarditis can mimic myocardial infarction, and (3) the importance of early diagnosis in the ED and transfer to a tertiary care facility.- - - - - - - - - - ranking = 1keywords = health (Clic here for more details about this article) |
6/64. Lethal or life-threatening allergic reactions to food.Fatal or life-threatening anaphylactic reactions to food occur in infants, children and adults. Atopic individuals with bronchial asthma and prior allergic reactions to the same food are at a particularly high risk, whereby even the mere inhalation of the allergenic food can be fatal. Not only peanuts, seafood and milk can induce severe, potentially lethal anaphylaxis, but indeed a wide spectrum of foods, according to the different patterns of food sensitivity in different countries. Foods with "hidden" allergens and meals at restaurants are particularly dangerous for patients with food allergies. Similarly, schools, public places and restaurants are the major places of risk. However, the main factor contributing to a fatal outcome is the fact that the victims did not carry their emergency kit with adrenaline (epinephrine) with them. In cases of death where food anaphylaxis is suspected, it is important for forensic reasons to preserve uneaten portions of the food in order to identify (hidden) allergens. It is also important to determine postmortem specific serum IgE, tryptase and histamine levels to document the anaphylaxis. There is a need to raise awareness of the diagnosis and treatment of anaphylaxis among doctors, those called upon to administer emergency medical care, and the public, and also to provide increased support for those with potentially fatal food allergies through the help of patients' organizations, and national and international medical societies. The food industry should ensure a policy of comprehensive labelling of ingredients so that even the smallest amount of potentially lethal foodstuffs can be clearly identified. Finally, the pharmaceutical industry should be persuaded to reintroduce an adrenaline inhaler onto the market.- - - - - - - - - - ranking = 1.0309232664259keywords = international (Clic here for more details about this article) |
7/64. Gamma hydroxybutyric acid (GHB): an increasing trend in drug abuse.The use of recreational drugs in society is becoming a widespread problem increasing the workload of all the emergency services. Gamma hydroxybutyric acid (GHB) is one of these, a drug used primarily for its euphoric effect. Toxic effects of ingestion include bradycardia, slow respiration or apnoea, coma and death. We present seven cases, all of which had consumed GHB either alone or in conjunction with other drugs and alcohol. The presentation, clinical features and management of these cases are described. All health care personnel involved in the emergency setting need to know of its existence, toxic effects and initial management with particular reference to airway control and possible assisted ventilation.- - - - - - - - - - ranking = 1keywords = health (Clic here for more details about this article) |
8/64. Airbags and bilateral eye injury: five case reports and a review of the literature.We report five cases of bilateral eye injuries from airbag deployment in motor vehicle crashes and review the world's literature on ocular injuries associated with airbags. The cases in the literature were identified by cross-referencing medline searches from airbags and ocular injuries. Additional cases were identified after review of references from each article in the search. An additional 89 cases from the literature were identified and are included for discussion. patients were treated individually in a noncontrolled, nonrandomized fashion according to the nature of each injury with regular follow-up examinations in clinic. Of the 94 cases studied, 24 (27%) were bilateral eye injuries, and 15 (16%) patients were wearing spectacles at the time of the accident. The most common injuries included corneal abrasions, eyelid trauma, and hyphemas. Outcomes ranged from complete resolution of symptoms and return of normal visual acuity to primary enucleation. This report describes the wide spectrum of eye injuries that may occur after airbag deployment. We suggest a management plan for the evaluation and treatment of the ocular complications of airbag-related trauma.- - - - - - - - - - ranking = 0.0079012345679012keywords = world (Clic here for more details about this article) |
9/64. Post traumatic high-flow arterial priapism. The need for increased awareness among health care professionals.High flow arterial priapism is a rare urological emergency. Presentation, diagnosis and institution of definitive management are often delayed. We describe our experience with this diagnostic entity and reviewed the literature to define possible reasons for the delayed diagnosis and management. We report two patients (10 years and 35 years old) that presented following blunt perineal trauma. The presentation and diagnosis of arterial priapism were delayed in both patients. Selective angiogram of the internal pudendal artery revealed arteriocavernous fistula in each patient. Embolization of the fistulae by gel foam was carried out at the same sitting. Penile detumescence was noted in both patients at the conclusion of the angiographic embolization. Both patients regained erectile function 3 and 6 weeks post treatment. awareness of the various etiologic factors in priapism is of paramount importance to establish the correct diagnosis and institute the appropriate treatment modalities. Absence of pain and preservation of potency in patients with arterial priapism are among factors that contribute to the delayed presentation, diagnosis and treatment. We reiterate the valuable role for selective internal pudendal artery angiography as a single investigation that provides both diagnostic and therapeutic means of management.- - - - - - - - - - ranking = 4keywords = health (Clic here for more details about this article) |
10/64. negotiating the new health care system in Cape Town, south africa: five case studies of the acutely chronically ill.This article examines the experiences of chronically ill disadvantaged patients in a newly reformed health care system against a backdrop of inequalities still prevalent in the wider postapartheid sociopolitical economy of the Western Cape, south africa. patients negotiated a hierarchy of spaces at the national level of transformation and policy and at community-, secondary-, and tertiary-level facilities. The institutionalization of patients meant that expensive medical treatment was mobilized in accordance with different stages of illness and that certain services were available only to "qualifying" categories of diagnoses.- - - - - - - - - - ranking = 5keywords = health (Clic here for more details about this article) |
| | Next -> |