The American journal of emergency medicine
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Dislocations and subluxations at the metacarpal-phalangeal joint are rare and volar or palmar subluxations represent a small fraction of these. A 54-year-old man presented with an injury to his right hand; he had heard a pop while putting down a weight. He had normal vital signs, and his examination revealed a deformity at the third metacarpal-phalangeal joint. ⋯ Attempts at closed reduction in the emergency department were unsuccessful, and he was splinted with plans for follow-up. There are several characteristics of this injury that present a diagnostic challenge: most patients are able to make a fist due to intact flexor mechanism, the deformity is subtle and may be masked by swelling, and lateral radiographs tend not to image the joint well. Recognition of this injury and hand surgery consultation are essential because most described cases required open reduction.
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The aim of this study was to determine the clinical characteristics of, antibiotic therapy for, and clinical outcome of Pseudomonas aeruginosa infection among bacteremic adults who visit the emergency department (ED). ⋯ For bacteremic adults who visited the ED, P aeruginosa was associated with a high mortality rate and a high proportion of empirically inappropriate antibiotic therapy. Identification of clinical predictors of P aeruginosa bacteremia would improve the quality of care and the use of appropriate antibiotics in the ED.
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Historically, pain has been poorly managed in the pediatric emergency department (ED) (PED), resulting in measurable psychosocial issues both acute and delayed. ⋯ Protocolized pain management reduces patients' memory of pain during PED visits but may not affect parental memory of perceived pain or parent- and patient-reported pain at discharge.
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Women with acute coronary syndrome appear to be treated less aggressively than men. However, little is known about potential sex biases in the evaluation of patients with low-risk chest pain admitted to emergency department (ED) chest pain units. ⋯ This study demonstrates no association between physician discretionary uses of stress testing based on sex. There is a need for further research on patient- or provider-specific factors that determine stress use and on how differences may affect clinical outcomes.
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The transmission of medical images and other data over mobile phone networks may facilitate remote medical consultations between neurosurgeons and regional hospitals treating spinal injury patients. The aim of this study was to compare the efficacy of mobile phone consultations with standard hospital workstation consultations in spinal injury patients. ⋯ Mobile phone consultations for patients with spinal injuries was as effective as workstation consultations. Mobile phone consultations can increase the expertise available to regional hospitals, which are often the first responders to medical emergencies.