The American journal of emergency medicine
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The aim of this study was to describe the use and efficacy of low-dose (≤2 mg) droperidol for the treatment of primary headaches (ie, migraine, cluster, tension-type headache and trigeminal autonomic cephalalgias, and other primary headaches) in the emergency department (ED). ⋯ The administration of low-dose (≤2 mg) droperidol may be safe and effective for the treatment of primary headaches in the ED.
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We sought to assess the anatomical distribution of traumatic pneumothoraces (PTXs) on chest computed tomography (CT) to develop an optimized protocol for PTX screening with ultrasound in the emergency department (ED). ⋯ Our results indicate that 80.4% of right- and 83.7% of left-sided traumatic PTXs would be identified by scanning regions 9, 11, and 12. These findings suggest that a standardized protocol for PTX screening with ultrasound should include these regions.
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In pediatric ankle injury, radiography is the current standard used to differentiate fracture from ligamentous injury; however, the associated cost, increased time, and radiation exposure pose a significant downside to this imaging modality. Point-of-care ultrasound may be an attractive alternative in this setting, as illustrated by this patient case. ⋯ The results of a formal radiograph confirmed this diagnosis. This case report presents the successful use of point-of-care ultrasound for detection of a Salter-Harris I ankle fracture, describes a stepwise approach for this new diagnostic technique in detail, and discusses its value in the setting of pediatric ankle injury.
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Comparative Study
Comparison of conservative management and laparotomy in the management of stable patients with abdominal stab wound.
The management of the hemodynamically stable patients with penetrating abdominal stab wounds is a problematic issue among trauma surgeons. ⋯ Our study showed that conservative management of asymptomatic and stable patients with anterior abdominal stab wound with physical examination can decrease the rate of normal laparotomy and the length of hospitalization and help to start diet earlier. This study made this hypothesis that after 17 hours of observation, diet can be started for the stable asymptomatic patients.
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The identification of clinical characteristics that could identify patients at high risk for Pseudomonas aeruginosa or Acinetobacter baumannii bacteremia would aid clinicians in the appropriate management of these life-threatening conditions, especially in patients admitted to the emergency department (ED) with community-onset infections. To determine clinical risk factors for P. aeruginosa or A. baumannii bacteremia in patients with community-onset gram-negative bacteremia (GNB), a post hoc analysis of a nationwide bacteremia surveillance database including patients with microbiologically documented GNB was performed. Ninety-six patients with P. aeruginosa or A. baumannii bacteremia were compared with 1230 patients with Escherichia coli or Klebsiella pneumoniae bacteremia. ⋯ In regards to the site of infection, pneumonia was more common in P. aeruginosa or A. baumannii bacteremia, whereas a urinary tract infection was less frequently seen. Factors associated with P. aeruginosa or A. baumannii bacteremia in multivariate analysis included pneumonia (odds ratio [OR], 3.60; 95% confidence interval [CI], 1.86-6.99), hematologic malignancy (OR, 2.71; 95% CI, 1.26-5.84), male sex (OR, 2.17; 95% CI, 1.31-3.58), solid tumor (OR, 1.89; 95% CI, 1.15-3.12), and health-care-associated infection (OR, 1.88; 95% CI, 1.48-2.41). Our data suggest that an initial empirical antimicrobial coverage of P. aeruginosa or A. baumannii bacteremia should be seriously considered in patients with pneumonia, a hematologic malignancy, solid tumor, or health-care-associated infection, when GNB is suspected, even in community-onset infections.