Annals of emergency medicine
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A prototype large-bore intravenous tubing was developed and tested. Mean flow rates for blood (Hct 45%) and tap water were determined for several catheters at 600 mm Hg, 300 mm Hg, and gravity flow and were statistically analyzed by calculating the 95% confidence intervals. The degree of hemolysis during high pressure and flow was determined by measuring the plasma free hemoglobin using the spectrophotometric method. ⋯ Slightly higher heat gain resulted with slower infusion rates. We conclude that the prototype large-bore tubing and up to 600 mm Hg pressure provide rapid flow rates without significant hemolysis. Blood warming may be inadequate at higher flow rates.
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Randomized Controlled Trial Comparative Study Clinical Trial
Single-dose ceftriaxone treatment of urinary tract infections.
Single-dose antibiotic therapy for urinary tract infections in which no underlying structural or neurologic lesions are present holds the promise of greater patient compliance and convenience. We present the results of a study comparing a single intramuscular dose of a long-acting, third-generation cephalosporin, ceftriaxone, with a standard, five-day regimen of trimethoprim-sulfamethoxazole (TMS). Fifty-two patients were entered into the study. ⋯ There was no statistical difference between the groups in symptoms of dysuria, hematuria, frequency, flank pain, and nocturia (alpha = .05). The physical parameters of age, blood pressure, pulse, and temperature were similar in the two groups (alpha = .05), as were the types of infecting organisms (alpha = .05). When comparing the two regimens, the ceftriaxone group cure rate (18 of 20, 90%) was not found to be significantly different from that of the TMS-treated control group (13 of 13) (alpha = .05).
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The recognition and appropriate initial management of the patient with an acute cervical spine injury in the ED is important because of the devastating and catastrophic effects of spinal cord injury. The use of computed tomography (CT) scan compared with initial plain radiographs in the detection of acute blunt traumatic cervical spine injury was evaluated in 20 patients. There was a disparity between the plain film and the CT scan as read by an attending radiologist in 12 patients (60%). ⋯ In the remaining seven patients the plain film was read as "normal." CT scan, however, was normal in only three, and in four of these seven patients there was a discrepancy between the plain radiograph and the CT. Thus in four of 20 patients (20%) the plain film was read as "normal," while CT scan showed a fracture in our study. CT scan was superior to plain films in diagnosing cervical spine trauma, and it eliminated the false-positive (40%) and false-negative (20%) results obtained by relying on plain radiographs alone.