J Emerg Med
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain.
Acute low back pain is a common problem in the emergency department (ED). Effective management of acute pain enhances early rehabilitation and recovery. Given the importance of inflammatory mediators in pain generation and the adverse effects associated with opioids, it is logical to expect that a non-opioid agent with antiinflammatory and analgesic properties would provide excellent analgesia with fewer adverse effects. ⋯ Patients in the ACOD group reported significantly more adverse drug events and serious adverse drug events. Seven patients--all in the ACOD group--withdrew from the study because of adverse drug events. Based on comparable efficacy and a superior adverse event profile, ketorolac was preferable to acetaminophen with codeine for the treatment of acute low back pain in the ED.
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Randomized Controlled Trial Comparative Study Clinical Trial
Chemical restraint for the agitated patient in the emergency department: lorazepam versus droperidol.
Patients presenting to the emergency department with acute agitation frequently require physical and chemical restraint. To determine the efficacy of lorazepam vs. droperidol, we conducted a prospective, randomized study of violently agitated patients requiring chemical restraint. Patients were randomized to receive either lorazepam or droperidol i.v. ⋯ We conclude that droperidol produces a more rapid and better sedation than lorazepam at the doses used in this study in agitated patients requiring chemical restraint. Lorazepam is more likely to require repeat dosing than droperidol. Methamphetamine toxicity was present in the majority of patients in this study.
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Spinal epidural abscess due to nocardia is extremely rare. We report a patient who presented to our Emergency Department with a complaint of low back pain and fever, who was later found to have a spinal epidural abscess. ⋯ Magnetic resonance imaging scan is the imaging study of choice for diagnosing spinal epidural abscess. Treatment for nocardia spinal epidural abscess involves a combination of surgical debridement and prolonged sulfonamide administration.
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This prospective cohort study evaluated the effectiveness and safety of a selective discharge policy for patients treated with racemic epinephrine (RE) and intramuscular (IM) dexamethasone (DEX) in the emergency department (ED). Children younger than 13 years of age presenting to the ED with croup who were treated with RE and IM DEX and discharged home were enrolled in the study. Patients were discharged home if they were free of intercostal retractions and stridor at rest, following a 2 h observation period. ⋯ Eighty-two patients were enrolled in the study over a one year period. Six of these patients (7%) required follow up for croup within 48 h of discharge and 2 (2%) required admission. We conclude that a subset of patients with croup treated with RE and IM DEX in the ED can be safely discharged home.
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A 42-year-old man sustained a gunshot wound to the frontal process of the left maxilla just lateral to the nasal bone medial to the maxilla that caused profuse hemorrhage. Anterior and posterior nasal packing along with packing of the gunshot wound with Vaseline gauze did not control the hemorrhage. A 28 French (30-cc balloon) Foley catheter was placed directly into the wound, and bleeding stopped immediately upon inflation of the balloon with 30 cc of sterile water. Arteriography identified bleeding from an anterior branch of the maxillary artery that was successfully embolized.