ABSTRACT
Ibutilide is a Vaughan-Williams class III antiarrhythmic agent approved for chemical cardioversion of acute onset atrial fibrillation/flutter. Emergency physicians rarely use ibutilide despite its proven clinical value. We report a case of successful chemical cardioversion using ibutilide in a patient with atrial fibrillation and delayed ventricular depolarization (wide QRS complex). We recommend that ibutilide be considered for wider use in the emergency department and that further studies be conducted.
Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Sulfonamides/therapeutic use , Aged , Electrocardiography , Emergency Treatment , Humans , MaleABSTRACT
The safe and effective use of ketamine for sedation/analgesia by emergency physicians has been validated in the medical literature. Nonetheless, arbitrary restrictions of this medication to anesthesia practitioners have prohibited emergency physician use in some locations. We explore the scientific evidence related to the use of ketamine by emergency physicians for sedation/analgesia, the history of sedation, the operational definitions of conscious sedation and dissociative anesthesia, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) related standards. We conclude that ketamine sedation/ analgesia offers many specific advantages for emergency patients and that it is safely administered by emergency physicians in the appropriately monitored setting.
Subject(s)
Analgesics/therapeutic use , Anesthetics, Dissociative/therapeutic use , Conscious Sedation/methods , Emergency Medicine/methods , Emergency Treatment/methods , Ketamine/therapeutic use , Conscious Sedation/standards , Conscious Sedation/trends , Drug Monitoring , Emergency Medicine/standards , Emergency Medicine/trends , Emergency Treatment/standards , Emergency Treatment/trends , Evidence-Based Medicine , Humans , Joint Commission on Accreditation of Healthcare Organizations , Patient Selection , Practice Guidelines as TopicSubject(s)
Empathy , Physician's Role , Right to Die/legislation & jurisprudence , Risk Assessment , Suicide, Assisted/legislation & jurisprudence , Terminal Care/legislation & jurisprudence , Humans , Netherlands , Oregon , Suicide, Assisted/statistics & numerical data , United States , Withholding TreatmentABSTRACT
Traumatic asphyxia has often been described as a rare syndrome with little prognostic significance. In the authors' series, however, all cases secondary to deceleration injury or compression of the anterior thorax were associated with pulmonary injury. The signs of venous congestion of the face and anterior thorax are not always recognized in the emergency department where they should be most clinically evident. Increased awareness of this syndrome by emergency physicians will result in better reporting and understanding of its clinical implications.
Subject(s)
Asphyxia/diagnosis , Thoracic Injuries/complications , Adult , Aortography , Asphyxia/diagnostic imaging , Asphyxia/etiology , Biomechanical Phenomena , Disease Models, Animal , Female , Humans , Male , Middle Aged , Peritoneal Lavage , Physical Examination , Tomography, X-Ray ComputedABSTRACT
A case of accidental impaction of the external auditory canal by concrete in a construction worker seen at Orlando Regional Medical Center is reported. A general discussion of the pathophysiology of concrete-related injuries is included. Recommendations are made for the optimal emergency management of these type injuries.
