J Emerg Med
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Observational Study
Falls and Implementation of NEXUS in the Elderly (The FINE Study).
The incidence of cervical spine injuries (CSI) in people over 65 years of age from low-energy mechanisms is far greater than in younger populations. Algorithms and decision rules exist for selection of trauma patients requiring cervical spine imaging. ⋯ In our study, the NEXUS decision instrument was not a valid tool to rule out imaging for patients > 65 years of age presenting after a fall from standing height or less. We advocate the liberal use of CT imaging of the cervical spine in this cohort of patients to rule out cervical spine injury.
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Observational Study
The Assessment of Acute Pain in Pre-Hospital Care Using Verbal Numerical Rating and Visual Analogue Scales.
Prehospital care (PHC) pain evaluation is an essential patient assessment to be performed by paramedics. Pain intensity is frequently assessed using Verbal Numerical Rating Scale (VNRS) or Visual Analog Scale (VAS). ⋯ VAS performs as well as VNRS in assessing acute pain in PHC. VAS and VNRS must not be used interchangeably to assess acute pain; either method should be used consistently.
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Review Case Reports
A Review of Published Radiographic Indicators of Carpometacarpal Dislocation Including Their Application to Volar Dislocations Through a Case Study.
Carpometacarpal joint dislocation is an uncommon injury that is at risk of being overlooked on initial presentation. Dislocation in a volar direction is rare, with a number of case reports published in the literature. ⋯ We report a case of volar dislocation at our institution, and review the application of two reported radiographic signs of carpometacarpal dislocation to volar dislocation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Radiographic signs provide an aid to the emergency physician in the busy department. These are particularly helpful to rule out rare injuries. Carpometacarpal dislocations in a volar direction risk being missed by one radiographic sign reported in the literature, as this article highlights.
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In severe sepsis and septic shock, global tissue hypoxia is a key development preceding multi-organ failure and death. ⋯ Initial low OER was associated with severe organ dysfunction that resulted in high mortality with severe sepsis and septic shock. When patients had initial ScvO2 of > 70% but abnormally low OER, their in-hospital mortality was higher than in normal OER patients. Therefore, the OER should be considered when attempting to predict the outcome of septic patients using ScvO2 at an early stage of management for sepsis.
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Syncope is a common emergency department (ED) complaint. Recurrent syncope is less common, but may be concerning for serious underlying pathology. It often requires a broad diagnostic evaluation that may include neurologic imaging. ⋯ We present the case of a 75-year-old man with non-small-cell carcinoma who presented to the ED for recurrent syncope after coughing spells over the 2 weeks preceding his arrival at the ED. He had a normal cardiac evaluation, however, he had some subacute neurologic changes that prompted obtaining a computed tomography (CT) scan of the head. This led to the diagnosis of atraumatic subdural hematoma that was causing transient transtentorial herniation leading to the recurrent syncope. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware that recurrent syncope is a possible presentation of increased intracranial pressure that may be due to a mass lesion, particularly if the patient has any acute or subacute neurologic changes. Although this association with a subdual hematoma is rare, other cases of mass lesions leading to syncope after coughing spells have been reported in the literature.