Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
1% lidocaine versus 0.5% diphenhydramine for local anesthesia in minor laceration repair.
Our previous study demonstrated that 1% diphenhydramine is as effective as 1% lidocaine for anesthesia in minor laceration repair, but that it also is more painful to inject. The purpose of this study was to compare 0.5% diphenhydramine to 1% lidocaine for pain of injection and adequacy of local anesthesia. ⋯ Although not a replacement for lidocaine, diphenhydramine is a viable alternative for anesthesia in the repair of minor lacerations.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of digital versus metacarpal blocks for repair of finger injuries.
This study compared efficacy, degree of discomfort, and time to anesthesia of digital blocks and metacarpal blocks for digital anesthesia. ⋯ Digital block and metacarpal block, as described in this study, are equally painful procedures. Digital block, however, is more efficacious and requires significantly less time to anesthesia for the injured finger.
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To describe the syndrome of exercise-induced rhabdomyolysis and to investigate the relation between exercise-induced rhabdomyolysis and the development of acute renal failure. ⋯ Previous literature has described a 17% to 40% incidence of acute renal failure in rhabdomyolysis. None of our patients developed acute renal failure, signifying a much lower incidence of acute renal failure in exercise-induced rhabdomyolysis without nephrotoxic cofactors than in other forms of rhabdomyolysis.
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Previous studies, conducted mainly in ICUs, have shown low compliance with hand-washing recommendations, with failure rates approaching 60%. Hand washing in the emergency department has not been studied. We examined the frequency and duration of hand washing in one ED and the effects of three variables: level of training, type of patient contact (clean, dirty, or gloved), and years of staff clinical experience. ⋯ Compliance with hand washing recommendations was low in this ED. Nurses washed their hands significantly more often than either staff physicians or resident physicians, but the average hand-washing duration was less than recommended for all groups. Poor compliance in the ED may be due to the large number of patient contacts, simultaneous management of multiple patients, high illness acuity, and severe time constraints. Strategies for improving compliance with this fundamental method of infection control need to be explored because simple educational interventions have been unsuccessful in other health care settings.
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A profoundly hypothermic 5-hour-old infant in cardiac arrest was brought to the emergency department by paramedics. The infant was found wrapped in a garbage bag inside a freezer. She had been in the freezer for approximately four hours. ⋯ At the time of discharge from the hospital, she had no significant physical or neurologic problems. Neurologic examination at 4 months was normal. This report supports prior recommendations to aggressively rewarm severely hypothermic infants in cardiac arrest.