J Emerg Med
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Comparative Study
The role of an emergency department observation unit in the management of trauma patients.
During a 12-month period, 20,838 patients with acute traumatic injuries were seen in the Emergency Department (ED) of Denver General Hospital. Of these patients, 520 (2.5%) were admitted to the ED Observation Unit, a seven-bed acute care unit situated within the ED and sufficient data were available on 485 (93%) for inclusion into the study. Fifty-three (15.4%) of these observation unit patients required subsequent admission, 389 (80%) were discharged, and 16 (4%) left against medical advice. ⋯ These groups of patients were analyzed and compared with regard to severity of injury, length of stay, and discharge diagnosis. The observation unit is useful in the evaluation of blunt chest or abdominal trauma when work-up, including chest x-ray studies and peritoneal lavage, is initially negative and when drug or alcohol ingestion obscures the initial evaluation in the ED. An observation unit within the ED is cost-efficient and has proven very useful in the management of trauma victims.
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Acute otitis media is a common pediatric infection that requires appropriate evaluation of the young child to assure that there are no accompanying systemic infections or complications. The examination of the ear must not only assess the appearance of the tympanic membrane, but determine its mobility. Treatment should be initiated with antibiotics and symptomatic relief. Good follow-up must be arranged.
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Thirty-seven critical emergency department patients underwent attempts at external cardiac pacing over an 11-month period. Indications for pacing were asystole in 16, complete heart block (CHB) in 4, sinus bradycardia in 2, nodal bradycardia in 1, atrial fibrillation with bradycardia in 2, electromechanical dissociation in 1, idioventricular rhythm (IVR) in 10, and torsades de pointes in 1. Eight patients were successfully paced with improvement in their condition. ⋯ External cardiac pacemaking appears to be effective in hemodynamically significant bradycardia. It does not appear to be effective in most instances of asystole or IVR resulting from prolonged cardiac arrest. When applied to patients with a responsive myocardium, it may result in significant hemodynamic improvement and may be lifesaving.
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Case Reports
Fatal intracranial hemorrhage associated with phenylpropanolamine, pentazocine, and tripelennamine overdose.
Hemorrhagic cerebrovascular accident is an uncommon but serious complication of drug overdose. A case of fatal intracranial hemorrhage following overdose with phenylpropanolamine, pentazocine, and tripelennamine is presented. The pharmacology, pathophysiology, clinical presentation, and management of poisoning by these agents are discussed.
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Clinical Trial Controlled Clinical Trial
Lidocaine reduces intravenous diazepam pain.
We studied 41 consecutive patients receiving intravenous (IV) diazepam in the preoperative holding area to evaluate whether low-dose IV lidocaine could ameliorate pain of the diazepam injection. In a double-blind trial we found 1 cc of 1% lidocaine effective versus placebo at lowering the incidence of pain from 80% to 5% (P less than .001) and recommend its routine use as an antecedent to IV diazepam.