Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of intranasal sufentanil and midazolam to intramuscular meperidine, promethazine, and chlorpromazine for conscious sedation in children.
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Shock index (SI) (heart rate/systolic blood pressure; normal range, 0.5 to 0.7) and conventional vital signs were compared to identify acute critical illness in the emergency department. ⋯ With apparently stable vital signs, an abnormal elevation of the SI to more than 0.9 was associated with an illness that was treated immediately, admission to the hospital, and intensive therapy on admission. The SI may be useful to evaluate acute critical illness in the ED.
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To assess the need for cranial computed tomography (CT) in the emergency department evaluation of children with Glasgow Coma Scale (GCS) score of 15 after mild head injury with loss of consciousness. ⋯ The prevalence of intracranial hemorrhage in children with mild closed-head injury appears to vary with the presence of neurologic abnormalities and other noncranial injuries. After isolated head injury with loss of consciousness, children older than 2 years who are neurologically normal and without signs of depressed or basilar skull fracture may be discharged home from the ED without a cranial CT scan after careful physical examination alone.
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To analyze a standardized medical evaluation of alert, adult emergency department patients with new psychiatric symptoms. ⋯ Most alert, adult patients with new psychiatric symptoms have an organic etiology. We recommend performing a medical history, physical examination, SMA-7, calcium, CPK if there is possible myoglobinuria, alcohol and drug screens, computed tomography scan, and lumbar puncture as part of the medical clearance of these patients.