Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of bupivacaine and lidocaine/bupivacaine for local anesthesia/digital nerve block.
We compared the efficacy, degree of discomfort, and time elapsed before anesthesia of digital block with a combination of 1% lidocaine/.25% bupivacaine and with .25% bupivacaine alone. ⋯ Bupivacaine .25% digital block induces anesthesia in the same period of time and with equivalent pain of injection as a 1:1 lidocaine 1%/bupivacaine .25% combination. It is not necessary to use lidocaine/bupivacaine in an attempt to achieve faster onset of local anesthesia.
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Little is known about the accuracy and reliability of current triage methods. We examined agreement among observers with regard to the need for ED care and the ability to predict at triage the need for admission to the hospital and compared these findings with admission rates after medical evaluation and management. ⋯ We found great variability among physicians, nurses, and a computer program with regard to triage decisions. Comparison of the three groups' triage decisions with actual data after medical evaluation and management showed that none of the three performed well in predicting which patients required admission. Until triage methods are standardized and validated, triage decisions should not be used to determine the timeliness of access to emergency care.
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Cervical epidural hematoma is an uncommon cause of neck pain. It may occur spontaneously or after trauma and has also become associated with many underlying conditions. ⋯ She presented with transient hemiparesis and recovered without surgery. This case is unusual with respect to the patient's neurologic presentation and her spontaneous recovery without neurologic sequelae.