Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective, randomized trial of epinephrine, metaproterenol, and both in the prehospital treatment of asthma in the adult patient.
To compare the effectiveness and incidence of adverse reactions with three treatment regimens for asthma in adults in the prehospital setting. ⋯ Nebulized metaproterenol is as effective as subcutaneous epinephrine in the prehospital treatment of adult patients with acute asthma. The combination of these two treatments offered no additional clinical benefit in the patients we studied.
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Comparative Study
Clinical decision rules discriminate between fractures and nonfractures in acute isolated knee trauma.
To develop criteria that optimize clinical decisionmaking in the use of radiography after isolated knee trauma in adults. ⋯ Clinical decision rules are effective in detecting knee fractures with 100% sensitivity and with sufficient specificity to eliminate 29% of knee radiographs in the ED. These findings require prospective validation.
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To derive a highly sensitive decision rule for the selective use of radiography in acute knee injuries. ⋯ A practical, highly sensitive, and reliable decision rule for the use of radiography in acute knee injuries has been derived. Clinical application should await prospective validation of the rule.
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Comparative Study
Can a day 4 bone scan accurately determine the presence or absence of scaphoid fracture?
To evaluate the accuracy of day 4 bone scans in predicting the presence or absence of fracture in patients with "clinical scaphoid fracture." ⋯ Day 4 bone scans are an accurate means of ruling out scaphoid fracture. However, because of a significant number of false-positive scans at day 4, they do not reliably confirm the diagnosis of scaphoid fracture. The bone scans also permitted identification of several other wrist fractures that had not been radiographically apparent.
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Case Reports
Avulsion fracture of the anterior superior iliac spine presenting as acute-onset meralgia paresthetica.
Avulsion fracture of the anterior superior iliac spine is rare. Most cases occur in adolescents involved in competitive sports or vigorous exercise in which the sartorius and tensor fascia lata muscles are contracted strongly and suddenly against a hyperextended trunk. ⋯ We describe a patient with avulsion of the anterior superior iliac spine who presented with meralgia paresthetica. The symptoms resolved with conservative treatment.