Annals of emergency medicine
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Traumatic and unsuccessful lumbar punctures can cause substantial diagnostic ambiguity that may lead to unnecessary antibiotic use and hospitalization, in addition to patient discomfort. Risk factors for obtaining traumatic and unsuccessful lumbar punctures have been studied in a limited fashion only. We sought to determine patient, physician, and procedural factors associated with traumatic and unsuccessful lumbar punctures in children. ⋯ Of the factors associated with traumatic or unsuccessful lumbar punctures in children, advancement of the spinal needle with the stylet in place and lack of local anesthetic use are the most modifiable. Modification of these procedural factors may reduce the risk of traumatic or unsuccessful lumbar punctures in children.
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A recent change in the delivery of emergency care is a growing reluctance of specialists to take call. The objective of this study is to survey Oregon hospitals about the prevalence and magnitude of stipends for taking emergency call and to assess the ways in which hospitals are limiting services. ⋯ Problems with on-call coverage are prevalent in Oregon and affect hospital financing and delivery of services. A continuation of the current situation could degrade the effectiveness of the trauma system and adversely affect the quality of emergency care.
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Comparative Study
Pneumococcal bacteremia in febrile infants presenting to the emergency department before and after the introduction of the heptavalent pneumococcal vaccine.
Fever is among the most common presenting complaints of infants and children younger than 3 years who present to the emergency department (ED). The evaluation and management of the febrile child is evolving rapidly. We compare the proportion of pneumococcal bacteremia between febrile infants and children younger than 3 years who had and had not received the heptavalent pneumococcal vaccine and who had received blood culture tests in our ED. ⋯ Pneumococcal bacteremia was found to be lower in our patients who had received the heptavalent pneumococcal vaccine than in the patients who had not.
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Editorial Comment Review
Is hydroxocobalamin safe and effective for smoke inhalation? Searching for guidance in the haze.