A Rotated and Laterally Displaced Patellar Dislocation.

Background: Patellar dislocations are a common orthopedic emergency with several variants. The rarer variants include rotational dislocations. These often require open reduction in the operating room.

Duodenal diverticula: potential complications and common imaging pitfalls.

A duodenal diverticulum is a commonly encountered entity in gastrointestinal radiology with a wide variety of appearances. The purpose of this review is to describe the normal anatomy and embryology of the duodenum, discuss the differences between a true versus intraluminal duodenal diverticulum, and to highlight the normal appearance, potential complications, and imaging pitfalls of duodenal diverticula.

Prevalence of Staphylococcus aureus nasal colonization in emergency department personnel.

Study Objective: Nasal colonization with Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) can precede infection in patients and contacts. Although general population S aureus/MRSA rates are well described, the prevalence of S aureus and MRSA nasal colonization in emergency department health care workers is not defined. We seek to determine the prevalence of S aureus and MRSA nasal colonization among ED health care workers without evidence of an active site of staphylococcal infection and identify variables associated with colonization.

Emergency medicine resident interpretation of pediatric radiographs.

Objective: To examine the concordance of pediatric radiograph interpretation between emergency medicine residents (EMRs) and radiologists.

Methods: A prospective, observational study was performed in a university pediatric ED with an annual census of 60,000 visits. Radiographs ordered by EMRs from December 1993 through October 1994 were initially interpreted solely by the EMR, with subsequent unmasked final review by attending radiology staff.

Radiographic interpretation in the emergency department.

This study examined the concordance of radiographic readings between emergency department (ED) attending physicians and radiologists in a community teaching hospital. In addition, the incidents of misinterpretations leading to an alteration in patient care were also reviewed. All radiographs obtained from January through October 1993 were initially interpreted by ED attending physicians with subsequent final review by attending radiology staff.

The esophageal detector device: accuracy and reliability in difficult airway settings.

Introduction: The esophageal detector device (EDD) recently has been found to assess endotracheal (ET) tube placement accurately. This study describes the reliability of the EDD in determining the position of the ET tube in clinical airway situations that are difficult.

Methods: This was a prospective, randomized, single-blinded, controlled laboratory investigation.

Right lung ventilation in a porcine open-chest shock model.

Objective: To determine the effect of selective right lung ventilation on gas exchange and hemodynamics when compared with bilateral lung ventilation in a porcine open-chest shock model.

Methods: A randomized, controlled laboratory investigation was performed using a static hemorrhagic shock model in 12 adult swine undergoing thoracotomy. The animals were subjected to a fixed 40% circulating blood volume hemorrhage over 20 minutes.

Effect of nitrous oxide analgesia on pneumothorax.

Objective: To address whether spontaneous inhalation of 50% nitrous oxide (N2O) for up to 30 minutes adversely affects swine with pneumothorax (PNTX).

Methods: Five fasted, female swine (13-17 kg) were sedated with IV ketamine, intubated, and allowed to spontaneously inhale either 50% N2O or room air (RA) in a sequential crossover design in which each animal served as its own RA control. Small (group 1, 150 mL), medium (group II, 300 mL), and large (group III, 500 mL) PNTXs were created by instilling air into the left pleural space via an 18-Fr three-way Foley catheter.

Pediatric pain control and conscious sedation: a survey of emergency medicine residencies.

Objective: To determine the availability and relative use of pediatric analgesia and sedation at sites of U.S. emergency medicine residency training programs.

Activated charcoal surface area and its role in multiple-dose charcoal therapy.

The study hypothesis was to prove that increasing the surface area (SA) of activated charcoal (AC) will enhance theophylline elimination in multiple-dose AC therapy. Five healthy, nonsmoking, nonmedicated, volunteer men ranging from the ages of 18 to 24 years old were entered onto the study. A prospective, randomized, crossover study was conducted with each subject serving as their own control.

Therapeutic and diagnostic efficacy of adenosine in wide-complex tachycardia.

Wide-complex tachycardia is one of the most challenging problems faced by emergency physicians. Adenosine is an endogenous nucleoside that has gained recent popularity as an anti-arrhythmic drug in the setting of supraventricular tachycardia. We present the cases of two patients with stable wide-complex tachycardia in which adenosine was administered for therapeutic and diagnostic effects.

The comparative efficacy of various multiple-dose activated charcoal regimens.

Multiple-dose activated charcoal therapy is used in the management of poisoning emergencies to enhance the elimination of enterohepatically and enteroenterically secreted toxins. This study was conducted to determine if increasing the frequency of activated charcoal administration would enhance the elimination of a toxin. In this crossover study, five healthy adult volunteers were randomly assigned to either a control phase or one of three study phases.

Dextromethorphan poisoning reversed by naloxone.

Dextromethorphan, a common ingredient in cough syrups, has rarely been described to cause toxicity. The authors describe an unusual case of a known asthmatic presenting with somnolence, who appeared to be in end-stage respiratory failure. Her partial response to routine naloxone, 1 mg, was surprising.

Manual translaryngeal jet ventilation and the risk of aspiration in a canine model.

Study Objectives: Manual translaryngeal jet ventilation (TLJV) is a safe and effective method of maintaining normal ventilation in apneic subjects. Little data exist on the amount of airway protection afforded with this technique of airway management. We sought to evaluate the risk of aspiration during manual TLJV.

Correct positioning of an endotracheal tube using a flexible lighted stylet.

Endotracheal intubation is not without complications, among the most serious of these being misplacement of the endotracheal (ET) tube. Unrecognized esophageal placement is a lethal complication, but even when placed in the trachea, ET tubes can be displaced distally and enter a mainstem bronchus. Correct positioning of an ET tube is usually defined as the placement of the tube within the trachea approximately 5 cm above the carina.

Objective anterior cruciate ligament testing.

We examined subjects with the Stryker knee laxity tester as part of the clinical examination to determine its usefulness in evaluating the anterior cruciate ligament. We measured 123 athletes with no history of knee injury, as well as 30 patients with ACL injury proven by arthroscopy, and 11 injured patients with intact ACL at arthroscopy. We recorded anterior and posterior tibial displacement at 20 degrees of knee flexion and 20 lbs force in each direction.