The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
The efficacy of sublingual hyoscyamine sulfate and intravenous ketorolac tromethamine in the relief of ureteral colic.
A prospective, randomized, open-label, single-dose study was conducted in an emergency department (ED) of a tertiary care teaching hospital to evaluate the efficacy of hyoscyamine sulfate as compared to ketorolac tromethamine for the reduction of pain from ureteral colic in the ED. Patients were included if they were at least 18 years of age and presented to the ED with an initial history and physical examination consistent with ureteral colic. Ureteral calculi were confirmed by ultrasound or intravenous urogram. ⋯ Demographics and baseline pain scores were similar for each group. Decreasing trends in pain over time were observed for both treatment groups, with significantly greater pain reduction observed with ketorolac tromethamine as compared to hyoscyamine sulfate. Global evaluations of pain relief revealed better results in the ketorolac tromethamine group than in the hyoscyamine sulfate group, although this result was not statistically significant.
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Review Case Reports
Fatal colchicine overdose: report of a case and review of the literature.
Colchicine poisoning is an uncommon, but potentially life-threatening, toxicologic emergency. A case is reported of a 21-year-old woman who presented to the emergency department approximately 1 hour after ingesting 30 mg of colchicine in a suicide attempt. ⋯ Despite aggressive medical management, the patient suffered a cardiac arrest and died 8 days after the ingestion. The clinical features of colchicine poisoning are highlighted and current therapeutic options are discussed.
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Airway control is the initial priority in the management of the injured patient. The purpose of this investigation was to evaluate the experience of an aeromedical transport team in the utilization of rapid sequence induction (RSI) for endotracheal intubation in the prehospital setting. Records of a consecutive series of injured patients undergoing RSI between June 1988 and July 1992 by a university-based aeromedical transport team were reviewed for demographics, intubation mishaps, and pulmonary complications. ⋯ Failure to intubate occurred in three patients (4%). Performed under strict protocol by appropriately trained aeromedical transport personnel, RSI is an effective means to facilitate endotracheal intubation in the injured patient requiring definitive airway control. Pulmonary complications were related to injury severity and not to intubation mishaps.
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A pooled analysis was conducted of the seven studies on the clinical diagnostic effectiveness of the Ottawa ankle rules when used with adult patients in the emergency department (ED). The seven studies, conducted in university and community hospital EDs, had examined the sensitivity, specificity, and positive and negative predictive values of the Ottawa ankle rules. ED physicians applied the Ottawa ankle rules with adult patients who had blunt ankle injuries. ⋯ Thus, the Ottawa ankle rules should not be used for ruling in a fractured ankle or foot. This pooled analysis shows the Ottawa ankle rules to be effective as clinical practice guidelines for acute ankle and foot injuries in the adult ED patient. Patients with negative results when the rules are used are highly unlikely to have a fractured ankle or foot, but the diagnosis for positive patients is much less certain, suggesting the need for radiography.
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This study was conducted to describe the utilization of plain radiography in the initial evaluation of shoulder pain in the emergency department (ED) and assess the feasibility of developing guidelines for the selective use of shoulder radiographs by determining whether clinical variables are able to discriminate between subjects having therapeutically informative versus uninformative X-rays. The study was a chart review of all adult ED patients presenting to the Boston University Medical Center Hospital (Boston, MA) between January 1994 and January 1996 with a chief complaint that included shoulder pain. Subjects with X-rays were classified into two groups, those with therapeutically informative X-rays (ie, identified conditions requiring specific therapy) and those with therapeutically uninformative X-rays (ie, did not result in specific therapy). ⋯ These data show that X-rays for the initial evaluation of shoulder pain in the ED are overutilized. This preliminary model suggests that clinical variables are able to distinguish between patients with informative versus uninformative X-rays. Prospective studies are needed to derive valid decision rules for selective use of shoulder radiographs in the ED.