The American journal of emergency medicine
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A prospective, open-label study of the effectiveness of transnasal butorphanol in the treatment of pain resulting from musculoskeletal injuries. Twenty-eight patients with strains (n = 20), fractures (n = 6), contusions (n = 1), and stab wounds (n = 1) were included. All patients were examined by an attending level emergency medicine physician and deemed to have pain severe enough to warrant parenteral narcotic analgesia. ⋯ One patient discontinued participation in the study because of nausea. In this limited trial transnasal butorphanol proved to be a rapidly effective opioid analgesic. Further controlled studies comparing transnasal butorphanol with standard parenteral narcotics are needed.
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Because falls are common among the elderly and are associated with high morbidity and mortality, community surveillance has been recommended. The purpose of this study was to characterize the impact of falls among the elderly on emergency medical transport services (EMS) and to explore the potential for community surveillance of falls through the use of computerized EMS data. Computerized EMS data and United States census data for 1990 for persons aged > or = 65 in Forsyth County, NC, were used to produce EMS transport rates for falls and to make comparisons by age, gender, race, and residence (nursing home vs community). ⋯ EMS summons for older adults reporting a fall accounts for a significant portion (15%) of all transports in this county. Computerized EMS data demonstrated patterns of falls among the elderly that are consistent with known demographic factors. The potential for using computerized EMS data as a practical means of community surveillance should be further explored.
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To reduce the emergency treatment time of shock victims, resuscitation fluids can be infused into a patient via their sternum rather than through a peripheral vein. Successful use of this method requires manual infusion because available medical equipment is not capable of infusing the preferred resuscitation fluids into the sternum at the required flow rates. ⋯ The options were narrowed down to five schemes that were studied in depth. Finally, two schemes were picked, a compressed gas bag-within-a-bag design and a peristaltic design.
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The case of a 42-year-old latex-sensitive female who experienced urticaria, pruritus, soft tissue swelling, and significant hypotension during an outpatient barium enema is described. These signs and symptoms of anaphylaxis occurred immediately after enema tip insertion and before infusion of contrast material. ⋯ This patient experienced an IgE-mediated anaphylactic reaction to the latex enema tip. Emergency physicians need to be aware of the spectrum of latex-induced allergic reactions.
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Epidural empyema is an unusual cause of headache that may be encountered in the emergency department. The collection of suppurative fluid usually results from local spread of sinusitis, although many other predisposing factors have also been described. ⋯ The case of an adolescent who presented to our emergency department twice in 6 days with persistent headache is reported; cranial computed tomography performed on the second visit demonstrated bilateral epidural empyema. This entity is uncommon, but may certainly be encountered by the emergency physician.