European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Methamphetamine toxicity: treatment with a benzodiazepine versus a butyrophenone.
Patients with methamphetamine toxicity often present to the emergency department (ED) agitated, violent and psychotic. To determine the efficacy of a benzodiazepine versus a butyrophenone for chemical restraint we conducted a prospective, randomized study at a large urban university ED between January 1995 and January 1997. Patients were randomized to receive either lorazepam or droperidol intravenously. ⋯ Both drugs produced significant reduction in pulse, systolic blood pressure, respiratory rate, and temperature over 60 min. We conclude droperidol produces a more rapid and profound sedation than lorazepam for methamphetamine toxicity. Lorazepam is more likely to require repeat dosing than droperidol.
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Two cases of near-fatal aortic abdominal aneurysm (AAA) are described which were successfully stabilized by a new principle for exerting abdominal compression, the non-pneumatic medical antishock trousers (NP-MAST). Obviously, the compression obtained with the NP-MAST suffices for this dramatic emergency. ⋯ Moreover, it contains no manometers, which could detract the doctor's attention from more important measures. The need for endotracheal intubation in advance to application of any kind of abdominal compression (PASG or NP-MAST) is stressed.
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Letter Comparative Study Clinical Trial
Treatment of acute supraspinatus tendinitis: physiotherapy or steroid injection?
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Comparative Study
Accidental firearm injury in childhood--a predictor of social and medical outcome?
This paper reports register data on a consecutive series of 141 children and teenagers hospitalized due to firearm injuries during a 21-year period in a community with restrictive firearm laws. Most of the injuries were minor and hospitalization was short. Shot by an air gun resulting in an eye injury was the most frequent reason for hospitalization. ⋯ Criminality was higher among patients compared with controls and the former were younger at the time of the first crime compared with the latter. This study indicates that, irrespective of firearm laws, young people suffering from firearm injuries, even if the injury is classified as accidental, run a higher risk of becoming psychosocially disadvantaged and criminal as adults. This makes preventative measures highly necessary not only from a societal point of view, but also to avoid individual suffering in this high-risk group of youngsters.
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Mechanical airway obstruction secondary to retropharyngeal haematoma is a life-threatening emergency and should be anticipated in all cervical spine injure patients regardless of the severity of trauma. Most retropharyngeal haematomas described in the literature have involved complicating factors such as anticoagulant therapy, tumour, aneurysm, infection or major cervical spine injury. ⋯ He sustained an atlanto-occipital fracture-dislocation and a very large retropharyngeal haematoma which resulted in airway obstruction and a subsequent difficult intubation. We outline the normal anatomy of the retropharyngeal space, the pathogenesis of retropharyngeal haematomas, and outline techniques of intubation available.