J Emerg Med
-
We sought to determine how often Emergency Physicians (EPs) order plain radiographs (XRs) of the lumbosacral spine in evaluating patients with low back pain (LBP). In addition, we sought to determine what history and physical examination findings were statistically associated with the use of an XR. Patients evaluated in our Emergency Department (ED) between April 1, 1995 and September 30, 1995 for LBP were identified retrospectively by their ICD-9 discharge code. ⋯ In this series, only a small minority of patients with LBP had an XR done as part of their ED evaluation. The choice of which patients to image was determined by history and physical examination findings. We conclude that the EPs we studied are evaluating LBP as conservatively, if not more so, than physicians in other specialties.
-
The objective of this study was to determine whether helical computed tomography (CT) performed without oral or intravenous contrast agents is accurate in the evaluation of patients with suspected acute renal colic. One hundred consecutive patients with suspected renal colic or ureteral colic were referred by our institution's emergency department for unenhanced helical CT scans. We reviewed the original radiographic report for each patient and recorded the size and location of ureteral calculi and other concurrent urinary tract calculi, if any. ⋯ The room time for CT averaged 26 min, compared to 69 min for intravenous urography (IVU). The charge for CT was $600 compared to $400 for IVU in our institution. Unenhanced helical CT was fast and accurate in determining the cause of colic and proved to be highly accurate for emergency situations.
-
Although intravenous (i.v.) administration of antiepileptic drugs is the preferred route of therapy in status epilepticus, intramuscular (i.m.) delivery may provide a valuable alternative when there are obstacles to venous access. Compared to other treatment options such as rectal drug administration, which is as challenging as the i.v. route in a convulsing patient, the i.m. route is easier and less invasive. The two most commonly used first-line anticonvulsants, diazepam and lorazepam, may be administered i.m., but are absorbed from the i.m. site more slowly than midazolam. ⋯ Because of its water solubility, midazolam is rapidly absorbed from the injection site and has excellent local tolerability. The pharmacodynamic effects of midazolam can be seen within seconds of its administration, and seizure arrest is usually attained within 5 to 10 min. Case reports and a recent randomized trial that demonstrate the successful use of i.m. midazolam in the termination of epileptic seizures are reviewed.
-
Phytophotodermatitis is a skin eruption that occurs after contact with photosensitizing compounds in plants and exposure to UV light. There are two common presentations of phytophotodermatitis. ⋯ Many plants have been identified that contain furocoumarins (psoralens), including limes, lemons, and celery. We present a patient with an acute phototoxic eruption and hyperpigmentation after contact with limes during a beach vacation.
-
Pediatric resuscitation is challenging for the emergency physician because the diverse range in the age and size of the patients encountered complicates the appropriate selection of medications, equipment, and supplies. The following enhancements in the pediatric resuscitation room were made to facilitate effective management of critically ill neonates and children: 1) expanding the concept of the Broselow tape as the central color theme of organization of all medication doses and equipment; 2) use of a large, simplified, color-coded wall chart to define patient parameters; 3) color-coded equipment; 4) adjustable "break-away" resuscitation stretcher; and 5) equipment suspended from the ceiling: a) radiant warmer; b) suction, oxygen, and electricity; c) cardiac monitor and fluid controller; d) X-ray unit. These changes give the resuscitation team greater accessibility to both the patient and the needed resuscitation supplies.