Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Rectal thiopental compared with intramuscular meperidine, promethazine, and chlorpromazine for pediatric sedation.
We studied the hypothesis that rectal thiopental is an effective agent for emergency department pediatric sedation and may have advantages over a more traditional regimen. ⋯ Rectal thiopental is superior to this drug combination for pediatric sedation because it can be administered painlessly, has a more rapid onset and offset of action, and is of equal safety and efficacy at the dosage studied.
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To determine whether potentially life-threatening intra-abdominal injuries occur in the absence of multisystem trauma in children, and to determine the usefulness of physical examination and a pediatric triage score in the assessment of liver and spleen injuries in children. ⋯ We conclude that liver or spleen damage may be present in children without other injuries and must be considered with a high index of suspicion, and that neither the initial clinical findings nor the PTS reliably predicts liver or spleen injuries in children with focal abdominal injuries.
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Advance directives are becoming more common in the health care system in the United States. Advance directives include "living wills," "durable powers of attorney for health care," "do not resuscitate orders," and the newer "medical directive." They are designed to allow individuals to determine the course of their medical care in the event that they are no longer able to transmit the information to their physician. The US Supreme Court's recent Cruzan decision increased the importance of these legal instruments by declaring that "clear and convincing" evidence may be required by states in order to terminate life support in a patient unable to express his wishes about care. ⋯ Emergency physicians have the opportunity to assist their patients in advance by disseminating advance directives to those who have contact with the emergency department: patients, family members, friends, health care workers, emergency medical services personnel, and police. A plan is suggested that includes education, the availability of advance directives, personnel available to help with completion of the documents, and immediate entry of the directive into a medical chart, if requested. This is in conformance with a recent policy adopted by the American College of Emergency Physicians.
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The use of epinephrine auto-injectors for prehospital treatment of severe allergic reactions has become increasingly popular in recent years. Anxiety when patients are called on to use these spring-loaded devices may lead to complications. ⋯ The approach to the treatment of these complications has been varied in the literature, including local sympathectomy, topical nitrates, and either local or intra-arterial phentolamine. This potentially disabling case of epinephrine-induced vasospasm of digital arteries was treated successfully with local infiltration of phentolamine.
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To examine the variability and define the normal ranges of orthostatic vital signs in an emergency department population. ⋯ The data from this study indicate that there is a wider than expected variation in orthostatic vital signs among presumed euvolemic ED patients.