Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Lack of efficacy of 'weighted' radiographs in diagnosing acute acromioclavicular separation.
The efficacy of "weighted" films in diagnosing grade 3 acromioclavicular (AC) sprains not evident on plain (unweighted) films was evaluated. Eighty-three pairs of radiographs, taken with and without weights, of patients with suspected AC injury were studied. The films were read in a randomized and blinded manner by a staff radiologist. ⋯ In only three cases (4%) did weights cause the injured CC distance to increase and thereby unmask a grade 3 injury not evident on plain films. Further evidence that weights may not reliably elucidate the degree of AC joint injury is suggested by the fact that in several cases the weights actually caused the injured and uninjured CC distance to decrease. We conclude that the use of weighted radiographs lacks efficacy in unmasking grade 3 AC sprains on radiograph and we recommend that routine use of this technique be abandoned.
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We report the case of a 27-year-old man with bilateral chylothorax. The patient presented with shortness of breath and bilateral pleural effusions three days after a motor vehicle accident. ⋯ Bilateral chylothorax secondary to blunt trauma has rarely been reported. The etiology, pathogenesis, clinical presentation, and recommended therapy are reviewed.
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Controversy exists as to whether ethanol intoxication causes exaggerated hypotension or increased mortality during hemorrhagic shock. Previous studies have used anesthetized animals. This limits data interpretation as anesthetic agents, particularly pentobarbital, have well-documented effects on hemodynamics and the response to hemorrhage. ⋯ Data were analyzed using Student's two-tailed t test, and analysis of variance for repeated measures. There was no significant difference in survival time between the control (63.1 +/- 2.8 min) and ethanol (59.9 +/- 5.9 min) groups. Systolic blood pressure was significantly lower in the ethanol group after 15 minutes of hemorrhage (81 +/- 22 to 59 +/- 14 mm Hg, P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Little has been reported in the literature on the characteristics of existing and planned emergency medicine fellowships. To help answer important questions about fellowships, a 28-question survey was developed by representatives from the University Association for Emergency Medicine education and fellowship committees, the Emergency Medicine Residents' Association, and a health services researcher. This questionnaire was sent to all emergency medicine residency directors and known emergency medicine fellowship programs. ⋯ The fellowships primarily last one year, are research oriented, and place a large emphasis on toxicology, emergency medical services, and critical care. They are based mostly in university or university-affiliated hospitals, and will graduate physicians who stay in academic emergency medicine. The major problems with fellowships include inadequate funding and lack of adequate candidates.