The American journal of emergency medicine
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Hamate fractures represent only 2% to 4% of all carpal bone fractures because they require a large degree of force to the hand or wrist. This is a case report of a patient with hamate and capitate fractures after a punch injury. It details the minute change seen in routine 3-view radiographic imagery and indications for computed tomography. ⋯ The risks to not detecting a hamate body fracture are nonunion of the bone, posttraumatic arthritis, decreased grip strength, and decreased range of motion of the hand. Because of rarity, there is no criterion standard therapy, but the general approach is open reduction and internal fixation using Kirschner wires and wrist immobilization for a minimum of 8 weeks. A high degree of clinical suspicion on examination is required for the proper approach to confirm a hamate fracture.
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Letter Case Reports
The importance of lead aVR interpretation by emergency medicine physicians.
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Multicenter Study
Factors influencing the development of antibiotic associated diarrhea in ED patients discharged home: risk of administering intravenous antibiotics.
Antibiotic-associated diarrhea (AAD) and Clostridium difficile infection (CDI) are well-known outcomes from antibiotic administration. Because emergency department (ED) visits frequently result in antibiotic use, we evaluated the frequency of AAD/CDI in adults treated and discharged home with new prescriptions for antibiotics to identify risk factors for acquiring AAD/CDI. ⋯ Intravenous antibiotic therapy administered to ED patients before discharge was associated with higher rates of AAD and with 2 cases of CDI. Care should be taken when deciding to use broad-spectrum IV antibiotics to treat ED patients before discharge home.
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Opioid overdose (OD) is the primary cause of death among drug users globally. Personal and social determinants of overdose have been studied before, but the environmental factors lacked research attention. Area deprivation or presence of addiction clinics may contribute to overdose. ⋯ The identified clusters of increased incidence-urban overdose hotspots-suggest a link between environment characteristics and overdoses. This highlights a need to establish overdose education and naloxone distribution in the overdose hotspots.