The American journal of emergency medicine
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Many patients who seek emergency evaluation for recurrent chest pain have had negative cardiac evaluations, sometimes including normal coronary angiograms. Despite reassurance, many of these patients return to emergency departments with complaints of chest pain. ⋯ If panic disorder is identified, it can be successfully treated. This article explores the causes of recurrent nonischemic chest pain and offers treatment recommendations.
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Randomized Controlled Trial Comparative Study Clinical Trial
The efficacy of tepid sponge bathing to reduce fever in young children.
Tepid sponge baths distress febrile children, and their efficacy at reducing fever has not been established. This study compared fever reduction and with (1) acetaminophen alone and (2) acetaminophen plus a 15-minute tepid sponge bath. Twenty children, ages 5 to 68 months, who presented to the emergency department or urgent care center with fever of > or = 38.9 degrees C were randomized to receive (1) acetaminophen alone or (2) acetaminophen plus a 15-minute tepid sponge bath. ⋯ Subjects were monitored for signs of discomfort (crying, shivering, goosebumps). Sponge-bathed subjects cooled faster during the first hour but there was no significant temperature difference between the groups over the 2-hour study period (P = .871). Subjects in the sponge bath group had significantly higher discomfort scores (P = .009).
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The debate regarding risks and benefits of triaging nonurgent patients away from emergency departments (EDs) stems from widely varying estimates as to what proportion of ED visits are inappropriate. A study was undertaken based on the hypothesis that these discrepant estimates might be due to differences in how "appropriateness" is defined. This cross-sectional study included 596 ED patients. ⋯ Kappa values for agreement between indicators ranged from -0.04 to 0.31, indicating poor agreement beyond that expected due to chance alone. Decisions as to which ED visits are appropriate depend heavily on the criteria used. Limiting patients' access to EDs without the aid of a valid and reliable standard for what constitutes an appropriate ED visit could create harmful barriers to care.
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The emergency physician must be aware of the varied ways in which epiglottitis can present. This report discusses two adult patients who presented with symptoms and signs indicative of uvulitis who were found to have associated epiglottitis. ⋯ Management consisted of close observation and treatment with an intravenous antibiotic and corticosteroid. The emergency physician should consider the possibility of coexistent epiglottitis in the adult patient who presents with uvulitis.