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This review will provide a guide to ventilator management to aid the ED physician. Pulmonary physiology and adverse effects of artificial ventilation on the pulmonary system will be discussed. Assist control ventilation is the most common mode of ventilation and should be used initially for patients in the ED. Pitfalls of therapy and troubleshooting the ventilator will be reviewed, recognizing that the respiratory therapist is a valuable reference and capable of handling the majority of mechanical ventilation issues. Finally, difficult cases will arise requiring early consultation with a critical care specialist to provide optimal ventilation while avoiding complications.
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Applications particularly useful in the pediatric and adolescent patient populations will continue to gain wider recognition and acceptance by the physician community. Most ultrasound examinations are quick and simple to perform, and ED physicians can gain comfort and facility in performing these focused applications.
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This issue covers Part I of a two-part series on evaluation and management of sexual assault in the emergency department. Part I of the series discusses initial ED care, physical exam, and evidence collection. Part II will cover laboratory analysis, pharmacotherapy, disposition, follow-up, documentation, and court testimony.
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The authors of this issue point out that 3-11% of malpractice dollars paid are disbursed for wound-related cases. Although wound infections may occur despite proper wound care, the detection of tendon or nerve injuries as well as joint violations requires a higher index of suspicion. This months review of wound management and its pitfalls serves the reader well by keeping the practitioner attentive to the potential problems of wound care.
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