Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Nasal versus oral midazolam for sedation of anxious children undergoing laceration repair.
To compare the efficacy and safety of a single dose of midazolam, as an oral solution of 0.5 mg/kg, or nasal drops of 0.25 mg/kg, in children undergoing emergency department laceration repair. ⋯ A single dose of oral or nasal midazolam results in reduced anxiety and few complications in selected children undergoing laceration repair in the ED. The oral route was associated with fewer administration problems.
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To determine the rate and cause of death of patients who were evaluated in the emergency department and discharged and how the cause of death related to the ED visit. ⋯ Death after discharge from the ED is uncommon. The most common cause of unexpected, directly related death is ruptured aortic aneurysm.
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Fractures of the hip following seizure are uncommon but may have devastating consequences if allowed to go unrecognized. The presence of groin pain suggests hip pathology, but the ability to ambulate does not necessarily rule out fracture. ⋯ Given the powerful contractions that occur with convulsions, musculoskeletal pain following seizure should not be dismissed until fractures or dislocations have been ruled out. We report the case of a young man with bilateral hip fractures following seizure, illustrating the violent muscular forces possible.
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To describe the natural history of orbital emphysema and its management in the emergency setting. ⋯ Identification of orbital emphysema in the ED should prompt a careful search for associated injury. Consultation should be sought in the presence of orbital or ocular injury. Antibiotic prophylaxis is not necessary for clean wounds.
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Wound botulism is a rare infectious and toxicologic complication of trauma and i.v. drug abuse. Only 39 cases have been reported in detail in the English literature. ⋯ Although his history and physical examination were consistent with wound botulism, diagnosis and therapy were delayed because this rare disease was not considered initially in the differential diagnosis. Wound botulism should be considered in trauma patients and i.v. drug abusers who present with cranial nerve palsies and descending paresis.