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Page 1: Contents volume 12, 1994




VOLUME 12,1994


Page 2: Contents volume 12, 1994

The Journal of Emergency Medicine Cl EDITOR-IN-CHIEF Peter Rosen, MD, University ofcarifornia, San Diego, CA 0 ASSOCIATE EDITORS George Sternbach, MD, Stanford University, Stanford, CA

Ron M. Walls, MD, Harvard Medical School, Boston, MA Roger Barkin, MD, Rose Medical Center, Denver, CO James Ducharme, MD, CAEP, Montreal, Quebec, Canada

Cl MANAGING EDITOR Martha C. Martell, M.S., University of California, San Diego, CA

0 SECTION EDITORS Origiad Conbibutions John A. Marx, MD Charlotte, NC Clinical Communications/Adult Ron M. Walls, MD Boston, MA

Cltnleal Communlcations/Pedlatrlcs Roger Barkin, MD Denver, CO

Clitdcd Communiations/OB/CYN Jean Abbott, MD Denver CO

Selected Topics: Toxicology Kenneth Kulig, MD Denver, CO Prebospitd Care Peter T. Pons, MD Denver, CO

Disaster Medicine Irving Jacoby, MD San Diego, CA

Cardiology Commentary Steven Lowenstein, MD Denver, CO

Emergency Radiology Jack Keene, MD Poughkeepsie, NY

Cdtkd Cnrc Joseph Varon, MD Houston, TX

Wound Core Richard F. Edlich, MD, PhD Charlottesville, VA

Tecbrdques and Procedures George Sternbach, MD Stanford, CA

Emergency Medidne in Review Ann Harwood-Nuss, MD Jacksonville, FL

Emergency Case Records Richard Wolfe, MD Denver, CO

Medical Classics George Sternbach, MD Stanford, CA

Adnduistntioa of Emergency Medicine

Eugene Kercher, MD Bakersfield, CA

Ethics Kenneth Iserson, MD Tucson, AZ

Emergency Medicine and the Law Raymond Fish, MD Urbana, IL

Education Mary Ann Cooper, MD Chicago, IL

Hummdtles and Medldne Richard M. Ratzan, MD Farmington, CT

Canadian Perspectives James Ducharme, MD Montreal, Quebec, Canada

CAEP News Alan Drummond, MD Ottawa, Ontario, Canada

Book and Other Media Reviews Edward J. Otten, MD Cincinnati, OH

Abstracts Jedd Roe, MD Denver, CO


Tim Allen, MD Quebec, Canada

Robert Banka, MD San Diego, CA

Howard Bessen, MD Torrance, CA

Richard F. Clark, MD San Diego, CA

Joseph Clinton, MD Minneapolis. MN

Robert Dailey, MD Orinda, CA

Daniel Dan& MD Louisville, KY

Jan de Boer, MD, PhD Rijswijk, The Netherlands

Robert W. Derlet, MD Sacramento, CA

Peter Doris, MD Omaha, NE

Richard Feldman, MD Chicago, IL

E. John Gallagher, MD Bronx, NY

Robert S. Hockberger, MD Torrance, CA

Robert C. Jorden, MD Phoenix, AZ

Gene Kallsen, MD Fresno, CA

Alois F. Karlbauer, MD Salzburg. Austria

Martin S. Kohn, MD East Hills, NY

Robert Margulies, MD Hartford, CT

Vincent Markovchick, MD Denver, CO

James Mathews, MD Chicago, IL

John W. McGill, MD Minneapolis, MN

Kendall McNabney, MD Kansas City, MO

Ernest E. Moore, MD Denver, CO

John Moorhead, MD Portland, OR

Edward Newton, MD Los Angeles, CA

Carin M. Olson, MD Seattle, WA

Charles Perrott, MD Pietermaritzburg, South Africa

Charles Pollack, Jr., MD Phoenix, AZ

Thomas Purcell, MD Bakersfield, CA

Ernie Ruiz, MD Minneapolis, MN

Richard Salluuo, MD Albany, NY

Arthur Sanders, MD Tucson, AZ

Robert D. Slay, MD, Col, MC San Diego, CA

Mark Smith, MD Washington, DC

Eldar Soreide, MD Stavanger, Norway

Tsuyoshi Sugimoto, MD Osaka, Japan

Dr. John Vinen St. Leonards, N.S. W., Australia

Daniel D. Whitcraft III, MD Long Beach, CA

The Canadian Association of Emergency Physicians Wssociation Canadienne des M6decins d’llrgence

Tha officlal journal of the CAEP La Journal de Canadlan Aaaoclatlon of Emergency Physlclans L’Aaaociatlon Canadianna daa Mdclocins d’llrganco


Production Editor: Brian S. Jenkins, E-mail Address: [email protected] Editorial Offices: The Journal of Emergency Medicine, University of California, San Diego, Medical Center, 200 West Arbor Dr., San Diego, CA 921036676 Publishing, Subscription;and Advertlsing Offices: Eisevier Science inc., 660 White Plains Road, Tarrytown, New York 105915153, USA, E-mail Address: [email protected]; and Eisevier Science Ltd, The Boulevard, Langford Lane, Kidlington, Oxford OX5 lGB, England. Publbhsd bimonthly: Annual lnsritutional Subscription Rates 1995: North, Central and South America, US$320.00, Rest of World f215.90. Professional subscription rates 1995, which must be prepaid by personal cheque or credit card; North, Central and South America, US679, Rest of World f53. Sterling prices exclude VAT. Non-VAT registered customers in the European Community will be charged the appropriate VAT in addition to the price listed. Prices include postage and insurance and are subject to change without notice.

Page 3: Contents volume 12, 1994

Pergamon The Journal of Emergency Medicine, Vol 12, No 6, pp V-XXVI, 1994

Copyright 0 1994 Elsevier Science Ltd Printed in the USA. All rights reserved

0136-4619/94 $6.00 + .OO

The JoumaZ of Emergency icine VOLUME 12 INDEX

Contents Volume 12,1994

Volume 12, Number 1 1994

Robert W. Derlet Chui-Chung Tseng

Timothy E. Albertson

Robert Manfredini Massimo Gallerani

Raffaella Salmi Giiolamo tale

Mauro Pasin Maarlzlo Bigoni Carmelo Fersini

Charles M. Ruhl John H. Urbancic

Pamela A. Foresman Mary Jude Cox

George T. Rodeheaver Robert D. Zura

Richard F. Edllch

Neal T. Reich Ronald Moscati

Dietrich Jehle Mary Ciotoli

Steven Starling John P. Wei

Luanne F. Hallagan Mark Smith

Daniel J. DeBehnke Wllllam Brady


Original Contributions

1 Cocaine Toxicity and the Calcium Channel Blockers Nifedipine and Nimodipine in Rats

5 Circadian Variation in the Time of Onset of Acute Gastrointestinal Bleeding

11 A New Hazard of Cornstarch, an Absorbable Dusting Powder

15 The Impact of a Major Televised Sporting Event on Emergency Department Census

Clinical Communications

19 Acute Abdominal Pain in the Presence of He&-Corporeal Neurosensory Deficits

23 Profound Atelectasis Following Alkaline Corrosive Airway Injury

27 Vertebral Artery Dissection Due to Minor Neck Trauma

Page 4: Contents volume 12, 1994

VI The Journal of Emergency Medicine

Hitoshi Imaizumi 33 Kazumasa Tsunoda

Naohiro Ichimiya Tetsunori Okamoto

Akiyoshi Nsmiki

Michael Cherington 39 Francis J. Martorano

La Verne Siebuhr Richard L. Stieg Philip R. Yarnell

Vicken Y. Totten 43 Eva Hirschenstein

Pbillip Hew

Roneet Lev 49 Richard F. Clark

Heman F. Gomez 57 Jeffrey A. Brent

David C. Mnnoz, IV Robert F. Mimmack

Jonathan Ritvo Scott Phillips

Patrick McKinney

George Stembach 61 Joseph Varon

Alex E. Lechin 63 Joseph Varon

Richard F. Edlicb 69

Peter Rosen 73

Ron M. Walls 74

Charles V. Pollack, Jr. 75


Marla Markbam 8 1 Glenn C. Hamilton

Repeated Large-Dose Haptoglobin Therapy in an Extensively Burned Patient: Case Report

Childhood Lightning Injuries on the Playing Field

Selected Topics: Toxicology

Neuroleptic Malignant Syndrome Presenting Without Initial Fever: A Case Report

Neuroleptic Malignant Syndrome Presenting Without Fever: Case Report and Review of the Literature

Charcoal Stercolith with Intestinal Perforation in a Patient Treated for Amitriptyline Ingestion

Selected Topics: Critical Care Medicine

Critical Care Medicine: Introduction

Adult Respiratory Distress Syndrome (ARDS): The Basics

Emergency Forum

A Plea for Powder-Free Surgical Gloves


The Evolution of Education

Doing It Right the First Time-Updating Advanced Life Support in Rural Canada

Residency Research Requirements: Time for a Reappraisal?

Letters to the Editor


Objectives to Direct the Training of Emergency Medicine Residents on Off-Service Rotations: Internal Medicine II

Page 5: Contents volume 12, 1994

Index VII

Shirley Press Sue A. Russell Jan C. Cantor

Eva Jerez

Kathy C. Head Lucy Bradley-Springer

David Sklar

Daniel Mines

James T. B. Rourke

Sharhabeel Jwayyed 125

Joseph Varon 126

J. Stepben Huff 127

J. Stephen Huff 127












Administration of Emergency Medicine

Attending Physician Coverage in a Teaching Hospital’s Emergency Department: Effect on Malpractice

Ethics of Emergency Medicine

The HIV-Infected Health Care Worker: Legal, Ethical, and Scientific Perspectives

Humanities and Medicine

Gabrielle Takes Off

Canadian Perspectives

Rural Advanced Life Support Update Course



Reviews: Books

Maryland Institute for Emergency Medical Services Systems Shock Trauma/Critical Care Manual, edited by Dunham CM, Adams CR

Advanced in Trauma and Critical Care, Vol. 6, edited by Maul1 KI, Cleveland HC, Feliciano DV, Rice CL, Trunkey DD, Wolferth CC

Management of the Acutely Ill Neurological Patient, edited by Grotta JC

Non-Epileptic Seizures, edited by Rowan AJ, Gates JR

Calendar of Events


Les R&urn&

Keyword Index to Volume 12, Number 1

Instructions for Contributors

Volume 12, Number 2 1994


Original Contributions

Carlos Angueira 139 The Tilt Test: Effect of Diabetes Mellitus and Antihypertensive Regina Marshall Medication on Normal Values

Fred Goldner

Page 6: Contents volume 12, 1994

VIII The Journal of Emergency Medicine

Gregory D. Hobbs Donald M. Yeafy

Julie Rivas

Robert M. Smith Karen B. Van Hoesen

Tom S. Neuman

Joseph Varon J. Mario Gonzalez

George L. Stembach Ellen E. Bellairs

Charles M. Ruhl Sung Jin Park

Olumide Danisa Raymond F. Morgan

Bruno Papirmeister Frederick R. Side11 Richard F. Edlich

Lee S. Anthony Harvey N. Hlmel

Francis L. Counselman 167 An Unusual Presentation of Fitz-Hugh-Curtis Syndrome

Robert L. Hood

George M. Bosse Thomas M. Pope

John S. Rose Kristi L. Koenig

Lou Anne Plumhoff Wellford Theodore Martin Kelly

Judd E. HoBander Michael Lozano

PhiBip Fait-weather Evan Goldstein

Paul Gennis Gerard X. Brogan

David Cooling Henry C. Thode

E. John Gallagher

Glenn A. f-&be1 Kevin Hutton

Arthur Kanowitz Tom Neuman

Linda Martinson Peter Rosen

143 Equestrian Injuries: A Five-Year Review

147 Arterial Gas Embolism and Hemoconcentration

Clinical Communications

155 Tension Hydrothorax: A Rare Complication of Continuous Cyclical Peritoneal Dialysis

159 A Serious Skin Sulfur Mustard Burn From an Artillery Shell

Clinical Communications: OB/G YN

Selected Topics: Toxicology

17 1 Colchicine Poisoning

179 Recurrent Digoxin Overdose and Treatment With Digoxin-Specific Fab Antibody Fragments

Selected Topics: Cardiology Commentary

187 Code Blue: What’s New?

193 Survival With Acute Primary Coronary Artery Dissection: A Case Report and Review of the Literature

199 “Abnormal” Electrocardiograms in Patients With Cocaine-Associated Chest Pain Are Due to “Normal” Variants

Selected Topics: Prehospital Care

207 The Accuracy of ST Segment Deviation in Prehospital Cardiac Monitoring

Page 7: Contents volume 12, 1994

Index IX

Elder Sereide Johan Peder Smedvig

Svein Harboe Harry Mikkelsen

Olav Veum Eielsen

Gary M. Vilke David B. Hoyt

Michael Epperson Dale Fortlage

Kevin C. Hutton Peter Rosen

Kuniyuki Kaneko Edward H. DeMouy

Michael E. Brunet James Be&an

Margaret L. Keeler 231

Richard F. Clark Erik D. Barton

Marla Markham Glenn C. Hamilton

Richard F. Edlich 249

Anthony S. Taylor 255

Edward J. Otten 273

Ron M. Walls 274












Acute Epiglottitis in a Rural Area: Experiences With an Anesthesiologist-Staffed Ambulance Helicopter

Intubation Techniques in the Helicopter

Selected Topics: Emergency Radiology

Radiographic Diagnosis of Quadriceps Tendon Rupture: Analysis of Diagnostic Failure

Emergency Forum

Hands Across the Gap: A Novel Strategy


Pitfalls in the Administration of Digoxin-Specific Fab Fragments

Letter to the Editor


Objectives to Direct the Training of Emergency Medicine Residents on Off-Service Rotations: Internal Medicine III

Humanities and Medicine

Wake-Up Call for Living

Canadian Perspectives

Emergency Medicine Educational Objectives for the Undifferentiated Physician



Reviews: Books

Poisoning and Drug Overdose, edited by Olson KR

Clinical Anatomy for Emergency Medicine, by Snell RS, Smith MS

Calendar of Events


Les Resumes

Page 8: Contents volume 12, 1994

X The Journal of Emergency Medicine

283 Keyword Index to Volume 12, Number 2

I Announcement

III Instructions for Contributors

Volume 12, Number 3 1994


Original Contributions

Laurie Vande Krol 285 The Emergency Department Management of Near-Hanging Victims Richard Wolfe

Clinical Communications

Prem C. Shukla 293 Primary Sternal Osteomyelitis

Leslie W. Milne 299 Gastric Volvulus: Two Cases and a Review of the Literature John J. Hunter John S. Anshus

Peter Rosen

Jonathan Glauser 307 Dissection of the Vertebral Arteries: Case Report and Discussion Otis M. Hastings Michael Merwart Marita A. Volk

Miizhael Bahntge

Kenneth R. Veenema 317 Strangulation Associated With a Passive Restraint Shoulder Harness Seatbelt: Case Report

Karen MuUoy Restifo 321 Case Report: Sternal Fracture From a Seqtbelt Gabor D. Kelen

Michael T. Lynch 325 Model Rocket Engine Burn Injuries: The Need for Stricter Regulation Kenneth T. Bellian Richard F. Edlich Harvey N. Hituel

Alan L. Causey 331 Henoch-SchBnlein Purpura: Four Cases and a Review Bonnie N. Woodall

Nancy G. Wahl Cynthia L. Voelker

Emily S. Pollack

Clinical Communications: OB/G YN

Jordan D. Lipton 343 Ectopic Pregnancy in a Blunt Trauma Patient Michael H. Thomason

Selected Topics: Toxicology

Duane G. Hansen 347 Dapsone Intoxication: Two Case Reports Kathryn R. Challoner

Dallas E. Smith

Page 9: Contents volume 12, 1994

Index XI

Michael Schwartz 353 David Rodman

Steven R. Lowenstein

Jan de Boer 361

Valerie A. Roman0 369 Gilbert J. Toffol

David A. Guss 375

H. Range Hutson 385 Deirdre Anglin

William Mallon Michael Pratts, Jr.

Selected Topics: Cardiology Commentary

Recognition and Treatment of Multifocal Atria1 Tachycardia: A Critical Review

Selected Topics: Disaster Medicine

Public Health Measures Following a Nuclear Accident in The Netherlands

Selected Topics: Emergency Radiology

Confirmation of Traumatic Interhemispheric Subdural Hematoma by Magnetic Resonance Imaging

Emergency Medicine in Review

The Acquired Immune Deficiency Syndrome: An Overview for the Emergency Physician, Part I

Emergency Forum

Caught in the Crossfire of Gang Violence: Small Children as Innocent Victims of Drive-By Shootings

389 Letters to the Editor


Leslie R. Wolf 391 Objectives to Direct the Training of Emergency Medicine Residents on Glenn C. Hamilton Off-Service Rotations: Toxicology

Humanities and Medicine

John Graham-Pole 407 Healthcare

Canadian Perspectives

Anthony M. Herd 409 Isolated Bladder Rupture After Minor Trauma in a Patient With Neil G. Crofts Alcohol Intoxication Lindy M. Lee

John V. J. Girard Robert J. Sweetland

413 CAEP News

415 Abstracts

Reviews: Books and Other Media

J. Stephen Huff 423 Current Emergency Diagnosis & Treatment, edited by Saunders CE, Ho MT

J. Stephen Huff 423 Hazmed I, Emergency Department Response to a Hazardous Material Accident Patient, Video and training manual, RMC Medical, and Medical Operations at HAZMAT Incidents, Video, Emergency Film Group

Richard Ruddy 424 Pediatric Emergency Medicine, by Reisdorff EJ, Roberts MR, Wiegenstein JG

Page 10: Contents volume 12, 1994

XII The Journal of Emergency Medicine

Charles V. Pollack, Jr. 425 Glucagon in Acute Medicine: Pharmacological, Clinical and Therapeutic Implications, edited by Picazo J

427 Calendar of Events

429 Classifieds

43 1 Les R&urn&

435 Commonly Used Abbreviations

439 Keyword Index to Volume 12, Number 3

I Instructions for Contributors

Volume 12, Number 4 1994

Kazuaki Shinohara Hiroshi Iwama Yoichi Akama

Choichiro Tase

Edmond A. Hooker Frank B. Miller

Jayne L. Hollander Elaine M. Bukowski

Deborah J. Woolard Thomas E. Terndrup

Richard Scallion John P. Wei

William 0. Thomas Curtis N. Harris

Tancredi F. D’Amore Samuel W. Parry

John R. Mabee Thomas L. Bostwick

Mary Kaye Burke

Peter J. Mariani Sunil Sharma

441 Interpleural Block for Patients With Multiple Rib Fractures: Comparison With Epidural Block

447 Do All Trauma Patients Need Early Crossmatching for Blood?

453 Sedative-Analgesic Agent Administration in Children: Analysis of Use and Complications in the Emergency Department

Clinical Communications

463 Upper Gastrointestinal Hemorrhage From a Mallory-Weiss Tear Associated With an Occult Richter’s Hernia and Small Bowel Obstruction: To See the Forest as Well as the Trees in the Emergency Department

467 Bilateral Forearm and Hand Compartment Syndrome Following Thrombolysis for Acute Myocardial Infarction: A Case Report



Iatrogenic Compartment Syndrome From Hypertonic Saline Injection in Bier Block

Iatrogenic Tension Pneumothorax Complicating Outpatient Heimlich Valve Chest Drainage


Original Contributions

Page 11: Contents volume 12, 1994

Index XIII

Clinical Communications: OWGYN

Robert A. Martin 481 Ovarian Hyperstimulation Syndrome in the Emergency Department: Babak Edraki A Case Report

Robert L. Norris

Selected Topics: Toxicology

Kevin S. Merigian 485 Adrenergic Crisis From Crack Cocaine Ingestion: Report of Five Cases Lynda J. Park

Kenneth V. Leeper Randall G. Browning

Renee Giometi

David A. Guss

Roneet Lev Peter Rosen

Kim D. Hoang Charles V. Pollack, Jr.

J. Stephen Huff 521

E. John Gallagher 525 No Proof of a Difference Is Not Equivalent to Proof of No Difference

C. L. McArthur, III Julie Gorchynski

Chris Rooke Glenn Hamilton

Ray Fish Melvin Ehrhardt

John Graham-Pole

Anurag Saincher Neii Swirsky

Milton Tenenbein

Stephen Lloyd David Streiner







545 The Standard of Care




Emergency Medicine in Review

The Acquired Immune Deficiency Syndrome: An Overview for the Emergency Physician, Part 2

Prophylactic Lidocaine Use Preintubation: A Review

The Utility of Parenteral Glucocorticoids in the Emergency Department

Medical Classics

Dr. C. Miller Fisher’s Description of Acute Cerebellar Hemorrhage


Letters to the Editor


Objectives to Direct the Training of Emergency Medicine Residents on Off-Service Rotation in Cardiology, Part 1

Emergency Medicine and the Law

Humanities and Medicine

The Surgeon

Canadian Perspectives

Cyanide Overdose: Survival With Fatal Blood Concentration Without Antidotal Therapy

Burnout, Depression, Life and Job Satisfaction Among Canadian Emergency Physicians

Page 12: Contents volume 12, 1994

XIV The Journal of Emergency Medicine

567 CAEP News

569 Abstracts

Reviews: Books

Rashmi U. Kothari 577 Cerebrovascular Disorders in the 1990’s: Clinics in Geriatric Medicine, by Biller J

J. Stephen Huff 577 Emergency Radiology, edited by Redman HC, Purdy PD, Miller CL, Rollins NK

Edward J. Otten 578 Handbook of Medical Toxicology, edited by Viccellio P

John C. Sakles 579 Surgical Intensive Care, edited by Barie PS, Shires G

581 Calendar of Events

583 Classifieds

585 Les Resumes

589 Keyword Index to Volume 12, Number 4

591 Erratum

I Instructions for Contributors

Volume 12, Number 5’

Anne-Maree Kelly Mark Cohen

David Richards

Nancy D. Baker Hadi Kharazi Lisa Laurent

Andrew T. Walker Daniel S. Williamson

Barbara N. Weissman Amir Zamani

Ricardo Sanchez

Yukari Wakabayashi William II. Bush, Jr.



Original Contributions

593 Minimizing the Pain of Local Infiltration Anesthesia for Wounds by Injection Into the Wound Edges

597 The Efficacy of Routine Head Computed Tomography (CT Scan) Prior to Lumbar Puncture in the Emergency Department

Clinical Communications

603 Pneumoscrotum After Blunt Chest Trauma

‘The following Residents in Emergency Medicine at the University of California, San Diego Medical Center helped to compile this issue of The Journal of Emergency Medicine: Michele A. Grad, MD, Thomas J. Peitz, MD, Charles W. Simmons, MD, and Saralyn R. Williams, MD.

Page 13: Contents volume 12, 1994

Michael J. Lacqua Pradip Sahdev

Bishara C. Atiyeh Ahmad M. Zaatari

607 Widened Mediastinum in Acute Trauma: A Complication of Central Venous Catheterization

611 Necrotizing Fasciitis of the Upper Extremity

James A. Gilbert Emily S. Poilack

Charles V. Pollack, Jr.

615 Vogt-Koyanagi-Harada Syndrome: Case Report and Review

Selected Topics: Toxicology

Prentice A. Tom Christopher T. Morrow

Gabor D. Kelen

621 Delayed Hypotension After Overdose of Sustained Release Verapamil

Selected Topics: Cardiology Commentary

Brian Milier Andrew Cohen

Adele Serio Dennis Bettock

627 Hemodynamics of Cough Cardiopulmonary Resuscitation in a Patient With Sustained Torsades de PointesIVentricular Flutter

Selected Topics: Critical Care

Luviza J. Santos Joseph Varon

Ligia Pie-Aluas Arthur H. Combs

633 Practical Uses of End-Tidal Carbon Dioxide Monitoring in the Emergency Department

J. Pieter Noordzij Pamela A. Foresman

George T. Rodeheaver James V. Quinn

Richard F. Edlich


Selected Topics: Wound Care

Tissue Adhesive Wound Repair Revisited

John Rkht&d Mabee “’

Stephen f-f. Thomas C. Keith Stone

Jeffrey A. Kline Jeffrey W. Runge



Emergency Medicine in Review

Compartment Syndrome: A Complication of Acute Extremity Trauma

Emergency Department Treatment of Migraine, Tension, and Mixed-Type Headache

665 Streptococcal Pharyngitis: A Review of Pathophysiology, Diagnosis, and Management

Medical Classics

WilLtam J. Bromberg Richard F. Edifch

681 Joseph Larner’s Personal Odyssey: Search for the Cause and Cure of Non-Insulin-Dependent Diabetes Mellitus

Emergency Forum

Michael J. Tueth 685 Revisiting Fluoxetine (Prozac) and Suicidal Preoccupations


Ron M. Wails 689 Emergency Department Follow-Up of Emergency Conditions: Why Not?

Page 14: Contents volume 12, 1994

XVI The Journal of Emergency Medicine

Peter Rosen 690

Ray Fish 691

C. L. McArthur, III Julie Gorchynski

Chris Rooke Glenn C. Hamilton

Ray Fish 703

Murray WaIdman 707

David Murphy Mary Eisenhauer

Edward J. Otten

Joseph Varon











I Instructions for Contributors

The World of Emergency Medicine

Editorial Comment on A View From the Other Side


Objectives to Direct the Training of Emergency Medicine Residents on Off-Service Rotation in Cardiology, Part 2

Emergency Medicine and the Law

A View From the Other Side

Humanities and Medicine

There Are Still Cathedrals in Toronto

C&nadian Perspectives

The Utility of a Bone Scan in the Diagnosis of Clinical Scaphoid Fracture



Reviews: Books

Manual of Medical Therapeutics, 27th ed., edited by Woodley M, Whelan A

Current Medical Diagnosis and Treatment 1993, edited by Tierney LM, McPhee SJ, Papadakis MA, Schroeder SA

Calendar of Events


Les R&urn&

Keyword Index to Volume 12, Number 5

Volume 12, Number 6 1994


Original Contributions

GabrIelIa De Carli 737 Risk of Human Immunodeficiency Virus Infection for Emergency Vincenzo Puro Department Workers

Nancy J. Binkin Giuseppe Ippolito

The Italian Study Group on Occupational Risk of HIV Infection

Page 15: Contents volume 12, 1994

Steven T. Moss Richard F. Clark

David A. Guss Peter Rosen

Janiae Jagger Robert D. Powers

Juanita S. Day Don E. Detmer Beth Blackwell

Richard D. Pearson

S. P. Ros S. L. Reynolds

D. M. Bhisitkul S. P. Ionides R. J. Handa

Kenneth C. Sanders Woodworth B. Clum, III

Steve S. Nguyen Subramaniam Balasubramaniam

Timothy J. Mader

Mark R. Pearson Ralph B. Leonard

Hitoshi Imaizumi Yoshihito Ujike Yasufumi Asai

Masamitsu Kaneko Susumu Chiba

745 The Management of Sharps in the Emergency Department: Is It Safe?

753 Epidemiology and Prevention of Blood and Body Fluid Exposures Among Emergency Department Staff

767 Plasma Beta-Endorphin Levels and Childhood Intussusception

77 1 End-Tidal Carbon Dioxide Detection in Emergency Intubation in Four Groups of Patients

Clinical Communications

779 Acute Diverticulitis in Young Adults

783 Posterior Sternoclavicular Dislocation: A Case Report

789 Spinal Cord Ischemia After Cardiac Arrest

Selected Topics: Toxicology

Jim Perez 795 Airway Compromise and Delayed Death Following Attempted Central Brent T. Burton Vein Injection of Propylhexedrine

Joseph G. McGirr

Jeffrey N. Love 799 Beta Blocker Toxicity After Overdose: When Do Symptoms Develop in Adults?

Selected Topics: Prehospital Care

I. Charles Sand 803 Maintenance Fluids in Prehospital Care: Crystalloid Versus Dextrose Andy Jagoda Solutions-Is There a Difference? David Vukich

Selected Topics: Disaster Medicine

David Phreaner 811 Disaster Preparedness of Home Health Care Agencies in San Diego Irving Jacoby County

Sue Dreier Nancy McCoy

Page 16: Contents volume 12, 1994

XVIII The Journal of Emergency Medicine

Timothy J. Bill Richard F. Edlich Harvey N. Himel

David J. Bentrem Elizabeth E. McGovern

Marie-Louise Hammarskjald Richard F. Edlich

Allan J. Brody George Stembach

Joseph Varon

Richard F. Edlich 839

Michael Yaron Ernest Ruiz

Matthew F. Bare&h

Anthony Herd Louis Ludwig


Robert C. Beveridge James Ducharme


James Ducharme 855

J. Stepben Huff

Edward J. Otten














Selected Topics: Wound Care

Electric Heating Pad Burns

Emergency Medicine in Review

Human T-Cell Lymphotrophic Virus Type-I (HTLV-I) Retrovirus and Human Disease

Medical Classics

Octave Landry: Guillain-Barr6 Syndrome

Emergency Forum

The Complex Legacy of the Sage of Monticello

Letter to the Editor

Administration of Emergency Medicine

Equipment Organization in the Emergency Department Adult Resuscitation Area

Canadian Perspectives

Relief of Posttraumatic Headache by Intravenous Chlorpromazine

Introduction to CAEP Consensus Documents

Emergency Pain Management: A Canadian Association of Emergency Physicians (CAEP) Consensus Document



Reviews: Books

Stroke: A Clinical Approach, by Caplan LR

Renal and Electrolyte Disorders (4th ed), by Schrier RW

Calendar of Events


Les R&urn&

List of Reviewers

891 Keyword Index to Volume 12, Number 6

Page 17: Contents volume 12, 1994

I Announcements

III Contents, Author, and Keyword index to Volume 12

XXVII Instructions for Contributors

Page 18: Contents volume 12, 1994

Author Index Volume 12,1994

Note: In brackets, br indicates book review, ed indicates editorial, and let indicates letter to the editor.

Akama, Y., 441 Albertson, T. E., 1 Anglin, D., 385 Angueira, C., 139 Anshus, J. S., 299 Anthony, L. S., 159 Asai, Y., 789 Atiyeh, B. C., 611

Bahntge, M., 307 Baker, N. D., 597 Balasubramaniam, S., 771 Baretich, M. F., 845 Barkin, R. M., [let] 529 Bellairs, E. E., 155 Bellian, K. T., 325 Bentrem, D. J., 825 Benzian, J., 225 Bettock, D., 627 Beveridge, R. C., 853 Bhisitkul, D. M., 767 Bigoni, M., 5 Bill, T. J., 819 Binkin, N. J., 737 Blackwell, B., 753 Bosse, G. M., 179 Bostwick, T. L., 473 Bradley-Springer, L., 95 Brady, W., 27 Brent, J. A., 57 Brody, A. J., 833 Brogan, G. X., 199 Bromberg, W. J., 681 Browning, R. G., 485 Brunet, M. E., 225 Bukowski, E. M., 447 Burke, M. K., 473 Burton, B. T., 795 Bush Jr., W. H., 603

Calb, G., 5 Cantor, J. C., 89

Causey, A. L., 331 Chadwick, P., [let] 529 Challoner, K. R., 347 Cheng, T. O., [let] 389 Cherington, M., 39 Chiba, S., 789 Ciotoli, M., 15 Clark, R. F., 49, [ ed] 233,745 Clum III, W. B., 771 Cohen, A., 627 Cohen, M., 593 Combs, A. H., 633 Cooling, D., 199 Counselman, F. L., 167 Cox, M. J., 11 Crofts, N. G., 409

D’Amore, T. F., 467 Danisa, O., 159 Day, J. S., 753 de Boer, J., 361 De Carli, G., 737 DeBehnke, D. J., 27 DeMouy, E. H., 225 Derlet, R. W., 1 Detmer, D. E., 753 Dreier, S., 811 Ducharme, J., 853,855 Dunn, J. D., [let] 843

Edlich, R. F., 11,69, 159,249, 325, 645,681,819,825,839

Edraki, B., 481 Eggen, J. T., [let] 235 Ehrhardt, M., 545 Eielsen, 0. V., 213 Eisenhauser, M., 709 Epperson, M., 217

Fairweather, P., 199 Fersini, C., 5 Fish, R., 545, [ed] 691,703

Foresman, P. A., 11,645 Fortlage, D., 217

Gallagher, E. J., 199, [ed] 525 Gallerani, M., 5 Gennis, P., 199 Gilbert, J. A., 615 Giometi, R., 485 Girard, J. V. J., 409 Glauser, J., 307 Goldner, F., 139 Goldstein, E., 199 Gomez, H. F., 57 Gonzalez, J. M., 155 Gorchynski, J., 533,693 Graham-Pole, J., 407, 553 Guss, D. A., 375,491,745

Hallagan, L. F., 23 Hamilton, G. C., 81,237,391,533,69 Hammarskjtild, M.-L., 825 Handa, R. J., 767 Hansen, D. G., 347 Harboe, S., 213 Harris, C. N., 467 Hastings, 0. M., 307 Head, K. C., 95 Hebel, G. A., 207 Herd, A. M., 409, 849 Hew, P., 43 Himel, H. N., 159,325,819 Hirschenstein, E., 43 Hoang, K. D., 507 Hobbs, G. D., 143 Hollander, J. E., 199 Hollander, J. L., 447 Hood, R. L., 171 Hooker, E. A., 447 Hoyt, D. B., 217 Huff, J. S., 521 Huff, J. S., [br (2)] 127, [br (2)] 423,

[br] 577, [br] 877


Page 19: Contents volume 12, 1994

Index XXI

Hunter, J. J., 299 Hutson, H. R., 385 Hutton, K. C., 207,217

Ichimiya, N., 33 Imaizumi, H., 33,789 Ionides, S. P., 767 Ippolito, G., 737 The Italian Study Group on Gccupa-

tional Risk of HIV Infection, 737 Iwama, H., 441

Jacoby, I., 811 Jagger, J., 753 Jagoda, A., 803 Jehle, D., 15 Jerez, E., 89 Jorden, R. C., [let] 235 Jwayyed, S., [br] 125

Kaneko, K., 225 Kaneko, M., 789 Kanowitz, A., 207 Keating, M. A., [let] 531 Keeler, M. L., 231 Kelen, G. D., 321, 621 Kelly, A.-M., 593 Kelly, T. M., 193 Kharazi, H., 597 King, J. W. R., 113 Kline, J. A., 665 Koenig, K. L., 187 Kothari, R. U., [br] 577 Krug, S. E., [let] 530

Lacqua, M. J., 607 Laurent, L., 597 Lechin, A. E., 63 Lee, L. M., 409 Leeper, K. V., 485 Leonard, R. B., 783 Lev, R., 49,499 Lindsey, D., [let] 531 Lipton, J. D., 343 Lloyd, S., 559 Love, J. N., 799 Lowenstein, S. R., 353 Lozano, M., 199 Ludwig, L., 849 Lynch, M. T., 325 Lyon, C., [let] 77

Mabee, J. R., 473,651 Mader, T. J., 779 Mallon, W., 385 Manfredini, R., 5 Mariani, P. J., 477 Markham, M., 81, 237

Marshall, R., 139 Martin, R. A., 481 Martinson, L., 207 Martorano, F. J., 39 McArthur III, C. L., 533,693 McCoy, N., 811 McGirr, J. G., 795 McGovern, E. E., 825 McKinney, P., 57 Merigian, K. S., 485 Mervart, M., 307 Mikkelsen, H., 213 Miller, B., 627 Miller, F. B., 447 Milne, L. W., 299 Mimmack, R. F., 57 Mines, D., 103 Morgan, R. F., 159 Morrow, C. T., 621 Moscati, R., 15 Moss, S. T., 745 Munoz, D. C., 57 Murphy, D., 709

Namiki, A., 33 Neal, J. M., [let] 78 Neuman, T. S., 147,207 Nguyen, S. S., 771 Noordzij, J. P., 645 Norris, R. L., 481

Okamoto, T., 33 Otten, E. J., [br] 273, [br] 578,

[ br] 723, [ br] 877

Papirmeister, B., 159 Park, L. J., 485 Park, S. J., 159 Parry, S. W., 467 Pasin, M., 5 Pearson, M. R., 783 Pearson, R. D., 753 Perez, J., 795 Phillips, S., 57 Phreaner, D., 811 Pit-Aluas, L., 633 Plumhoff Wellford, L. A., 193 Pollack Jr., C. V., [ed] 75, [br] 425,

507,615 Pollack, E. S., 331,615 Pope, T. M., 179 Powers, R. D., 753 Pratts Jr., M. J., 385 Press, S., 89 Puro, V., 737

Quinn, J. V., 645

Reich, N. T., 15 Restifo, K. M., 321 Reynolds, S. L., 767 Richards, D., 593 Ritvo, J., 57 Rivas, J., 143 Rodeheaver, G. T., 11,645 Rodman, D., 353 Romano, V. A., 369 Rooke, C., 533,693 Ros, S. P., 767 Rose, J. S., 187 Rosen, P., [ed] 73,207,217,299,499,

[ed] 690,745 Rourke, J. T. B., 107 Ruddy, R., [br] 424 Ruhl, C. M., 11, 159 Ruiz, E., 845 Runge, J. W., 665 Russell, S. A., 89

Soreide, E., 213 Sahdev, P., 607 Saincher, A., 555 Sakles, J. C., [br] 579 Salmi, R., 5 Sanchez, R., 597 Sand, I. C., 803 Sanders, K. C., 771 Santos, L. J., 633 Scallion, R., 463 Schwartz, M., 353 Serio, A., 627 Shannon, S., 559 Sharma, S., 477 Shinohara, K., 441 Shukla, P. C., 293 Sidell, F. R., 159 Siebuhr, L., 39 Sklar, D., 95 Smedvig, J. P., 213 Smith, D. E., 347 Smith, M., 23 Smith, R. M., 147 Starling, S., 19 Sternbach, G. L., 61, 155, 833 Stieg, R. L., 39 Stone, C. K., 657 Streiner, D., 559 Sweetland, R. J., 409 Swirsky, N., 555

Tase, C., 441 Taylor, A. S., 255 Tenenbein, M., 555 Terndrup, T. E., 453 Thode, H. C., 199 Thomas, S. H., [let] 78, 657

Page 20: Contents volume 12, 1994

XXII The Journal of Emergency Medicine

Thomas, W. O., 467 Thomason, M. H., 343 Toffol, G. J., 369 Tom, P. A., 621 Totten, V. Y., 43 Tseng, C.-C., 1 Tsunoda, K., 33 Tueth, M. J., 685

Ujike, Y., 789 Urbancic, J. H., 11

Van Hoesen, K. B., 147 Vande Krol, L., 285 Varon, J., 61,63, [br] 126, 155,633,

[br] 724, 833

Veenema, K. R., 317 Vilke, G. M., 217 Voelker, C. L., 331 Volk, M. A., 307 Vukich, D., 803

Wahl, N. G., 331 Wakabayashi, Y., 603 Waldman, M., 707 Walker, A. T., 597 Walls, R. M., [ed] 74,

[ed] 689 Wei, J. P., 19,463 Weissman, B. N., 597 Williamson, D. S., 597 Wolf, L. R., 391

Yarnell, P. R., 39 Yaron, M., 845 Yealy, D. M., 143 Young, R. A., [let] 389

[ br] 274, Zaatari, A. M., 611 Zamani, A., 597 Zura, R. D., 11

Wolfe, R., 285 Woodall, B. N., 331 Woolard, D. J., 453

Page 21: Contents volume 12, 1994

Keyword Index Volume 12

abdominal pain, 19,33 1,779 abdominal trauma, 343 accidents, 737 acute atelectasis, 23 acute gastrointestinal bleeding, 5 acute inflammatory dymelinating polyradiculopathy (AIDP),

833 acute rheumatic fever, 665 adrenergic beta receptor blockaders, 799 adult respiratory distress syndrome (ARDS), 63 adult T-cell leukemia/lymphoma, 825 advanced cardiac life support ( ACLS), 187 advanced life support education, 107 adverse effects, 477 AIDS, acquired immune deficiency syndrome, 375,491 airway compromise, 795 airway injury, 23 akathisia, 685 alkaline corrosive, 23 ALS Update Course, 107 amitriptyline, 57 amputation, 611 analgesia, 855 analgesics, 453 anesthesiology, 213 angina, 199 anoxic brain damage, 285 antibiotics, 611 antidepressant, 685 antidote, 555 antigen detection test, 665 antihypertension, 139 anti-mitotic, 171 arterial gas embohsm, 147 arthritis, 33 1 artillery shell, 159 ascites, 48 1 attending physicians, 89 automatic shoulder harness, 3 17

bacterial growth, 11 basic cardiac life support (BCLS), 187 benign early repolarization, 207 beta blocker intoxication, 799 bladder, 411 bromocriptine, 43 burn, 33,819 burnout, 559 burns, 159,325

capnography, 633,771 capnometry, 633,771 cardiac 789 arrest, cardiac monitoring, 207 cardiology, 533,693 cardiopulmonary resuscitation ( CPR), 187,627,789 cardiovascular response, 499 CDC guidelines, 95 central vein injection, 795 central venous cannulation, 607 cerebral contusions, 849 cerebral hemorrhage, 521 cerebral infarction, 521 cerebellar disease, 52 1 cerebrospinal fluid, 833 cervical spine injury, 285 charcoal, 57 chest trauma, 321 chest tubes, 477 children, 453 chlorpromazine, 849 chronobiology, 5 circadian rhythm, 5 clavicular dislocation, 783 cocaine, 1, 199,485 colchicine, 17 1 colon, 779 compartment syndrome, 467,473,651 complications, 453,477,607 computed tomography, 597 continuing medical education (CME), 107 continuous ambulatory peritoneal dialysis, 155 continuous cyclical peritoneal dialysis, 155 cornstarch, 11 coronary artery, 193 cough, 627 cough-CPR, 627 crack cocaine, 485 craniotomy, 369 crossmatch, 447 crystalloid, 803 CT scan, unenhanced, 597 curriculum, 255 cyanide, 555

dantrolene, 43 dapsone overdose, 347 D-chiro-inositol, 681 death, 1


Page 22: Contents volume 12, 1994

decompression, 147 depression, 559 detonator, 159 dexamethazone, 507 dextrose, 803 diabetes, 819 diabetes mellitus, 139 diagnostic failure, 225 digoxin overdose, 179 digoxin-specific Fab antibody fragments, 179 digoxin toxicity, 179 dihydroergotamine, 657 disaster medicine, 811 disaster planning, 811 disaster preparedness, 811 dissection, 193 diverticulitis, 779 dopamine, 43 drive-by shootings, 385 drug abuse, 795 drug therapy, 855

early repolarization, 199 education, 393,533,693 elderly, 811 electrocardiogram, 199,207 emergency, 321 emergency cardiac care, 187 emergency department, 89 emergency department treatment, headache, 657 emergency department utilization, I 5 emergency medical services, 213, 855 emergency medicine, 8 1,237 emergency medicine CME, 107 emergency medicine objectives, 393, 533, 693 emergency physicians, 559 emergency service, 737 emergency service, hospital, 845 emergency trauma, 65 1 emphysema, subcutaneous, 603 end-tidal carbon dioxide detection, 771 end-tidal CO*, 633 endorphins, 767 epidural block, 441 epiglottitis, 213 equestrian injuries, 143 equipment failure, 477 equipment organization, 845 esophageal hiatal hernia, 299 esophageal intubation, 771 ethical issues, 95 etiology, 477 excess risk, 745 expert, 545, 703

facility design and construction, 845 falx syndrome, 369 fever, 49 Fitz-Hugh-Curtis syndrome, 167

XXIV The Journal of Emergency Medicine

flaccid paraplegia, 789 fluoxetine, 685 forearm, 467 fracture carpal bones, 709

gang-related homicide, 385 gastric volvulus, 299 gastrointestinal bleeding, 331 Glasgow Coma Scale, 285 glucocorticoid steroids, 507 goals, 255 gout, 171 Guillain-Barre syndrome, 833

hand, 467 hanging, 285 haptoglobin, 33 head trauma, 849 headache, 657,849 health measures/preparedness, 361 heating pad, 819 Heimlich valve, 477 helicopter, 217 hematoma, 369 hemoconcentration, 147 hemoglobin, 33 Henoch-Schiinlein, 33 1 Hepatitis B, 753 Histoacryle blue, 645 HIV, 375,491,753 HIV-infected health care worker, 95 HIV seroprevalence, 737 home health care, 811 horse injuries, 143 host defenses, 11 human T-cell lymphotrophic virus type I-II, 825 hydrocortisone, 507 hydrothorax, 155 hypotension, 447,481, 621

imaging, 369 infection, 611,645 informed consent, 95 injuries, 27 insulin, 68 1 interior design and furnishings, 845 internal medicine, 81, 237 interpleural block, 441 intestinal obstruction, 57 intestinal perforation, 57 intracranial pressure, 499, 597 intraocular pressure, 499 intraperitoneal, 411 intravenous hypertonic saline, 473 intubation, 499 intubation, intratracheal, 77 1 intussusception, 767 iodine prophylaxis, 361 ischemic spinal cord injury, 789 isolated intoxication, 411

Page 23: Contents volume 12, 1994

job satisfaction, 559

labelling, 325 legal issues, 95 liability, 89 licensing, 8 11 lidocaine, 499 life satisfaction, 559 lightning injuries, 39 lithium, 49 local anesthesia, 593 lumbar puncture, 597

magnetic resonance T,-weighted imaging, 789 Mallory-Weiss tear, 463 malpractice claims, 89 mediastinal widening, 607 methemoglobinemia, 347 methyl prednisolone, 507 methylene blue, 347 microtubules, 17 1 migraine, 657 model rocket engine, 325 motor vehicle accident, 321 multifocal, 353 multiple trauma, 343 myocardial infarction, 199 myo-inositol, 681

nasotracheal intubation, 217 N-butyl-2-cyanoacrylate, 645 neck trauma, 307 necrotizing fasciitis, 611 needlestick, 745 negligence, 545,703 nephritis, 331 neuroleptic malignant syndrome, 43,49 neuroleptics, 43 neuropathy, 833 nifedipine, 1 nimodipine, 1 noncardiogenic pulmonary edema, 63 non-insulin-dependent diabetes mellitus, 681 nuclear accident or disaster, 361

objectives, 81,237, 255 occupational, 737 occupational exposures, 753 orotracheal intubation, 217 orthostasis, 139 ovarian hyperstimulation syndrome, 48 1 overdose, 485, 555

pain, 453, 593, 855 pain assessment, 855 pain control, 441 paraesophageal, 299 paralysis, 833 patient census, 15

pediatric firearm injury, 385 pelvic inflammatory disease, 167 penicillin, 665 perforated peptic ulcer, 167 perihepatitis, 167 plain radiograph, 255 playing field, 39 pleural effusion, 155 pneumothorax,477,603 poisoning, 171,485, 555 polypropylene, 645 posterior sternoclavicular dislocation, 783 pregnancy, 343 pregnancy tests, 343 pregnancy tubal, 343 prehospital care, 207, 803 prevention, 8 19 primary, 193 primary osteomyelitis, 293 prochlorperazine, 657 propylhexedrine, 795 Prozac, 685 pulmonary barotrauma, 147 pulmonary edema, 63 puncture wound, 745 purpura, 33 1

quadriceps, 225 quality, 545, 703

recurrent digoxin overdose, 179 reduce risks, 39 regional anesthesia, 441,473 renal failure, 33 residents, 81, 237, 393, 533,693 respiratory distress, 63 resuscitation, 187 review, 499 rib cage trauma, 441 Richter’s hernia, 463 right to work, 95 risk, 737 risk management, 89 rupture, 411

salpingitis, 167 scaphoid fracture, 709 screen, 447 scrotum, 603 seatbelts, 317, 321 sedatives, 453 seizures, 1 sensory deficits, 19 serotonin, 43 serotonin syndrome, 43 sharps, 745 sigmoid diverticulitis, 779 significant risks, 95 small bowel obstruction, 463

Page 24: Contents volume 12, 1994


soft tissue, 611 somatosensory-evoked potentials (SEP), 789 spina bifida, 819 spontaneous, 193 sports-related injuries, 143 ST segment, 207 staffing, 15 standard, 545,703 Staphylococcus aureus, 293 stercolith, 57 sternal fracture, 321 sternoclavicular dislocation, 783 sternum, 293 strangulation, 3 17 streptococcal pharyngitis, 665 stroke, 307, 521 suicide, 285, 685 sulfur mustard, 159 sumatriptan, 657 surgical gloves, 11 suture, 645 syringomyelia, 19

tachycardia, 353 technetium bone scan, 709 tendon rupture, 225 tension pneumothorax, 477 therapy, 477 thoracentesis, 155 thoracic outlet injury, 783 throat culture, 665 thrombolysis, 199, 467

The Journal of Emergency Medicine

Tilt Test, 139 tissue adhesive, 645 toxicity, 485 toxicology, 393 training, 81,237, 533, 693 transfusion, 447 trauma, 217,321,369,447,603,607 trauma complications, 651 treatment, 353 trilafon, 49 tropical spastic paraparesis, 825 type, 447

universal precautions, 753 urinalysis, 33 utilization, 545,703 uveitis, 615

ventilators, 811 ventricular dysrhythmia, 627 verapamil, 621 vertebral artery, 27 vertebral artery dissection, 307 vertibrobasilar system, 307 violent street gangs, 385 Vogt-Koyanagi-&rada syndrome, 615 volume depletion, 139

weakness, 833 wound healing, 645 wounds, 27,593 wounds and injuries, 709