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We used a Ralks eye magnet (no longer manufactured) to remove magnetic foreign bodies in four consecutive patients with metallic soft tissue foreign bodies. In all four cases, the foreign body was quickly located, requiring minimal soft tissue exploration, time, and radiography.

This paper reports a one-month-old female with a one-week history of low grade fever and rhinorrhea, and one day of intermittent cough and cyanosis. The signs and symptoms are typical for pertussis in an infant less than six months old. The incidence of pertussis in the neonate and infant appears to be increasing. The disease still carries significant morbidity and mortality, especially in this age group. Pertussis should be included in the differential diagnosis of protracted cough with cyanosis or vomiting, persistent rhinorrhea, and marked lymphocytosis in children under six months of age.

We reviewed the charts of patients returning within 72 hours to our emergency department to determine whether monitoring revisits is a useful quality assurance indicator. Patient visits for June and December 1987 were selected to eliminate a potential seasonal difference. Of the 13,261 visits during these two months, 455 (3.4%) were revisits within 72 hours. Charts were available on 444 patients, of whom 407 (91.7%) represented cases in which the return and the initial visits were clearly related. Charts were reviewed for deficiencies in medical management, appropriate prescribed follow-up, patient education, and patient compliance. Suspected medical management problems were discussed by the three senior authors, and a consensus decision was made. Return visits were considered avoidable if a deficiency was noted in at least one of the areas listed above. There were 297 unscheduled related return visits, 96 (32.3%) of which were avoidable. Of these avoidable visits, 38 (39.6%) had medical management deficiencies, 14 (14.6%) had inappropriate prescribed follow-up, 20 (20.8%) had not been given proper education, and 35 (36.5%) were due to patient noncompliance. Of the 110 scheduled return visits, there was one (0.9%) deficiency in medical management and none in the other categories. Of the unscheduled return visits, 146 (49.2%) returned within 24 hours; 89 (30.0%) between 24 and 48 hours; and 62 (20.8%) between 48 and 72 hours. Of the avoidable visits, 85% returned within 48 hours, as did 92% of those with medical management deficiencies.(ABSTRACT TRUNCATED AT 250 WORDS)

The concept of transcutaneous external cardiac pacing has been present for approximately 200 years. However, it was not until the early 1950s that transcutaneous pacing was practical. Implantable pacemakers were introduced in the late 1950s, superceding the more cumbersome and uncomfortable external models. Recent technologic improvements and the development of paramedic services have led to a resurgence of emergently placed external pacemakers, particularly for patients with symptomatic bradycardias and bradyasystolic cardiac arrests in both prehospital and emergency department settings. A review of the history, mechanics, and research of external pacemakers is presented.

Electromechanical dissociation (EMD) has been described as "organized electrical depolarization of the heart without synchronous myocardial fiber shortening and, therefore, without cardiac output." However, little evidence demonstrating this description exists. We wished to determine whether mechanical activity is present during EMD. Twenty-two patients presenting with, or subsequently developing EMD in the emergency department from April 1986 to January 1987 were studied. Echocardiograms were performed during five-second pauses in CPR, using the subxiphoid approach. Nineteen patients (86%) had synchronous myocardial wall motion. In two others, there was a rhythmic change in the echocardiographic density of the myocardium, without visible chamber narrowing. In one there was no visible myocardial response associated with the QRS complex. One or more cardiac valves were visualized in 17 patients. Of these, valvular motion was seen in 15 (88%), but only four exhibited visible valve closure. In our study population, the majority of patients in EMD had myocardial wall and valve motion. Thus, the term "electromechanical dissociation" may be a misnomer.

It has been reported that the finding of a normal PaO2 level on arterial blood gas analysis does not exclude the diagnosis of acute pulmonary embolism. We wished to determine whether a more thorough evaluation of the blood gases would prove more helpful; specifically, whether it is possible for a patient with acute pulmonary embolism to have a normal alveolar-arterial (A-a) oxygen gradient. We studied this question in a patient population in which the diagnosis was definitively made via pulmonary arteriography. Sixty-four patients met all study criteria. In these patients, the A-a gradient ranged from 11.6 to 83.9 mm Hg (mean, 41.8 mm Hg). In three patients, the A-a gradient was normal for age. We conclude that a normal A-a oxygen gradient does not exclude the diagnosis of acute pulmonary embolism, and should not preclude further diagnostic procedures if there is a high index of suspicion.

Early electrical therapy for patients with ventricular fibrillation and ventricular tachycardia can result in a significant increase of lives saved from sudden cardiac death. Rapid defibrillation has become a goal of prehospital and emergency department cardiac care, and the use of automatic external defibrillators can aid in reaching this objective. The history, mechanics, and implications of automatic external defibrillators are presented.