The American journal of emergency medicine
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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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Olanzapine (Zyprexa; Eli Lilly, Indianapolis, IN) is an antipsychotic medication that has been useful in the treatment of psychiatric disorders. In cases of overdose, cardiovascular and neurologic changes are seen. ⋯ Treatment with lipid emulsion resulted in amelioration of the symptoms. Inadvertent discontinuation of a lipid emulsion infusion led to recurrence of symptoms, which quickly resolved with an additional loading dose of lipid emulsion.
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Mild therapeutic hypothermia has been shown to improve outcomes after adult cardiac arrest but remains underused. Development of easier methods than currently exist to induce therapeutic hypothermia may help increase use of this treatment. We developed a mathematical model to evaluate the potential to induce mild therapeutic hypothermia through the esophagus. ⋯ Our computer simulations suggest that inducing mild therapeutic hypothermia via an esophageal route is feasible.
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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.