J Emerg Med
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Identification of fluid in the elbow joint by physical examination alone can be challenging. Ultrasound can assist in the diagnosis of elbow effusion, and guide aspiration of the effusion. ⋯ Ultrasound-guided arthrocentesis of the elbow from a posterior approach is a helpful technique to guide the aspiration of the painful swollen elbow.
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The threat of rifles in the hands of criminals is now well recognized within law enforcement. Current emergency response systems are not equipped to operate in this combat-like environment. Growing statistics indicate that of the peace officers that were killed in the line of duty in the United States nearly half died by gunfire evidence. ⋯ It is time for the emergency medical system to evolve to meet the critical needs of today's law enforcement environment.
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Angiotensin-converting-enzyme inhibitors (ACEI) are one of the most prescribed medications worldwide. Angioedema is a well-recognized adverse effect of this class of medications, with a reported incidence of ACEI angioedema of up to 1.0%. Of importance to note, ACEI angioedema is a class effect and is not dose dependent. The primary goal of this literature search was to determine the appropriate Emergency Department management of patients with ACEI angioedema. ⋯ The literature search did not support any specific treatment protocol with a high level of evidence due to the limited--and limitations of the--available studies.
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Controlled Clinical Trial
Resident-Initiated Advanced Triage Effect on Emergency Department Patient Flow.
Emergency Department (ED) overcrowding is a national problem. Initiating orders in triage has been shown to decrease length of stay (LOS), however, nurse, physician assistant, and attending physician advanced triage have all been criticized. ⋯ Resident-initiated advanced triage is an effective method to decrease patient LOS, however, our effect size is smaller than predicted and did not significantly affect the percent of patients leaving before medical screening.
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Angioedema (AE) is characterized by nonpitting edema of the dermis and subcutaneous layers. The most common sites of involvement are the tongue, lips, face, and throat; however, swelling can also occur in the extremities, genitalia, and viscera. Life-threatening airway swelling can also occur. AE may be allergic or nonallergic. The overall lifetime incidence of AE is reported to be as high as 15%. ⋯ New HAE medications that correct imbalances in the kallikrein-kinin system may prove safe and efficacious in the treatment of ACEi-AE.