Annals of emergency medicine
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To examine the ability of a unified metropolitan paramedic system to provide IV access in children when indicated. ⋯ Although paramedics had an 84% success rate at establishing IV lines in children in the field, half the children younger than 6 years who required intravascular access did not receive an IV line in the prehospital setting. Multiple IV line attempts should be discouraged because additional attempts yield little benefit and may prolong transport times.
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Hip fractures in awake patients are rarely subtle in their clinical presentation. We report two cases of occult, comminuted, intertrochanteric hip fractures that occurred in awake, elderly patients who were brought to the emergency department for evaluation of other medical conditions. Neither patient complained of hip pain, and both were transported to the ED without spinal immobilization. ⋯ Radiographs of both patients revealed comminuted intertrochanteric hip fractures. In an elderly, nonambulatory patient who may have fallen prior to evaluation, routine radiographs of the pelvis and hip should be performed followed by plain tomography, computed tomography, bone scan, or magnetic resonance imaging as indicated to rule out occult hip fracture. Even comminuted intertrochanteric hip fractures can present in an occult fashion; therefore, a high index of suspicion must be maintained for these injuries.