Annals of emergency medicine
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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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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.
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To determine which adult patients with new-onset seizures require admission and whether those who require admission can be identified in the emergency department. ⋯ One half of patients with new-onset seizures require admission. Patients with new-onset seizures who require admission can usually be detected by a standardized medical evaluation in the ED.
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To determine whether there is an association between the race of a victim of out-of-hospital cardiac arrest and the provision of bystander-initiated CPR. ⋯ Black victims of out-of-hospital cardiac arrest receive bystander CPR less frequently than white victims. Targeted training programs may be needed to improve the rates of bystander CPR among certain groups.