Annals of emergency medicine
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To evaluate the ability of emergency medical technician-paramedic (EMT-P) units to become and remain proficient in the performance of the intraosseous infusion procedure. ⋯ EMT-P units can successfully perform the intraosseous infusion line procedure in patients of all ages. Proficiency is maintained over time despite its infrequent use by individual EMT-Ps.
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To demonstrate the usefulness of cranial computed tomography (CT) in the emergency department evaluation of HIV-infected patients and patients with risk factors for HIV infection who present with neurologic complaints. ⋯ CT detected clinically significant neuropathology among our study patients. Because lesions and mass effect were associated with nonfocal as well as focal presentations, CT is indicated in every neurologically symptomatic patient with HIV infection or risk factors for infection. Because HIV-related diseases can progress rapidly, repeat CT is recommended even in patients with recent scans.
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To determine the clinical characteristics associated with early post-traumatic seizures in children with head trauma. DESIGN, SETTING, AND TYPE OF PARTICIPANTS: Retrospective chart review; urban trauma center/pediatric emergency department. Trauma patients aged 3 months to 15 years given discharge diagnosis ICD-9-CM codes indicating head trauma and seen from 1988 to 1990 were eligible for the study. ⋯ In the pediatric head trauma patient, a GCS score of 3 to 8 appears to be predictive of post-traumatic seizures. The data from this retrospective study are consistent with the hypothesis that prophylactic phenytoin reduces post-traumatic seizures in the pediatric head trauma patient with a low GCS score.
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To study patients with acute trauma retrospectively for clinical predictors of positive cranial computed tomography. ⋯ Our data suggest that it may be possible to effectively screen patients with head trauma for cranial computed tomography using clinical criteria and so reduce the current number of scans performed by more than half. However, a prospective study is required to confirm our results.
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Hypotension resulting from calcium channel blocker ingestion often is refractory to standard therapeutic modalities. Amrinone and glucagon have been used separately and in combination with other agents in the treatment of calcium channel blocker overdose. ⋯ The use of the two agents together may provide improved inotropic support with minimal increases in myocardial oxygen consumption. In this case, the combination of amrinone and glucagon was safe and effective in the management of the hemodynamic instability associated with calcium channel blocker overdose.