Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Clinical Trial
Lower-extremity Doppler for deep venous thrombosis--can emergency physicians be accurate and fast?
Clinical diagnosis of lower-extremity (LE) deep venous thrombosis (DVT) requires confirmation by an imaging study before committing the patient to anticoagulation therapy. Studies have shown that demonstrating compressibility of leg veins under ultrasound is accurate for ruling out DVTs when performed by vascular specialists. Although LE Doppler has become the preferred test for diagnosing DVTs, it is not always available 24 hours per day. ⋯ Emergency physicians can perform LE duplex ultrasound examinations accurately and quickly.
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Randomized Controlled Trial Clinical Trial
Bier block exsanguination: a volumetric comparison and venous pressure study.
Intravenous regional anesthesia (IVRA) is a useful ED anesthetic technique. However, venous pressure elevation during injection can cause anesthetic leakage and toxicity. This is minimized by preinjection limb exsanguination. Although standard, Esmarch exsanguination is intolerable with limb trauma. Thus, the authors' objective was to study alternative methods. ⋯ While Esmarch was the most effective exsanguinating method, the two alternatives provided significant and equivalent decreases in limb volume. The AE/AC technique was physiologically effective in preventing attainment of MVP. Further studies are indicated to determine the clinical effectiveness of this technique in providing anesthesia for patients with limb trauma.
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Emergency medical services (EMS) systems increasingly seek to triage patients to alternative EMS resources. Emergency medical services dispatchers may be asked to perform this triage. New protocols may be necessary. Alternatively, existing protocols may be sufficient for this task. For an existing dispatch protocol to be sufficient, it at least must accurately categorize patient condition and severity based on an external standard. ⋯ Certain dispatcher-assigned NC and SC codes and NC/SC combinations achieved the study threshold. Overall agreement failed to achieve the threshold. The lowest SC level was rarely assigned, preventing a meaningful analysis of all severity levels.
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Suturing of bite wounds remains controversial. The authors evaluated the incidence of wound infection in 145 mammalian bite wounds treated with primary closure. ⋯ The data suggest that carefully selected mammalian bite wounds can be sutured with approximately a 6% rate of infection. This infection rate may be acceptable in lacerations where cosmesis is a primary concern.
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Editorial Comment Review
Whose turf is it, anyway? Diagnostic ultrasonography in the emergency department.