The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of tetracaine-adrenaline-cocaine (TAC) with topical lidocaine-epinephrine (TLE): efficacy and cost.
Topical anesthesia in the form of TAC (tetracaine, adrenaline, cocaine) solution has been used for wound repair. This pilot study was designed to determine if the topical anesthesia achieved using a mixture of lidocaine (5%) and epinephrine (1:2000) (TLE) is equivalent to the topical anesthesia obtained using a solution of tetracaine (0.5%), epinephrine (1: 2000), and cocaine (10.4%) (TAC). A prospective, randomized, double-blind trial was carried out from May 1992 to August 1992 at a community-based teaching hospital Emergency Department (ED) that receives 50,000 annual visits. ⋯ Seventeen patients were in the TLE group; 18 in the TAC group. The mean ages were compared and found to be similar (P = .40) between the two test groups. The pain scale values, the diameter of tissue blanch around laceration (halo size), and the time to laceration repair from the onset of application of anesthetic were compared and no difference was shown between the TAC and TLE groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Review Case Reports
Removal of a hardened steel ring from an extremely swollen finger.
For several years various authors have discussed the removal of rings from swollen fingers. Removal normally has involved cutting the ring, but nondestructive methods of removal using string frequently have been recommended as well. A case is reported of a patient who presented with a hardened roller bearing on an extremely swollen index finger, which defied all attempts at removal by previously successful methods. ⋯ The blood pressure cuff, which was used while the elastic band was removed, prevented the refill of the tissue while the finger was examined. Four sessions of compression lasting approximately 10 to 15 minutes each with the elastic band were necessary to eliminate the edema and release the ring. The ring was finally removed utilizing a short piece of string to ease it over a small laceration.
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Comparative Study
Clinical impact of radiograph misinterpretation in a pediatric ED and the effect of physician training level.
Radiograph interpretation in the pediatric emergency department (ED) is commonly performed by pediatric emergency medicine (PEM) attendings or physicians-in-training. This study examines the effect of physician training level on radiograph interpretation and the clinical impact of false-negative radiograph interpretations. Data were collected on 1,471 radiographs of the chest, abdomen, extremity, lateral neck, and cervical spine interpreted by PEM attendings, one PEM fellow, one physician assistant, and emergency medicine, pediatric and family practice residents. ⋯ Twenty (1.4%) radiographs had clinically significant (false-negative) misinterpretations, including 1.7% of physician-in-training and 0.8% of attending interpretations (P = 0.15). No morbidity resulted from the delay in correct interpretation. Radiograph misinterpretation by ED physicians occurs but is unlikely to result in significant morbidity.
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Review Case Reports
Ovarian torsion: an unusual cause of abdominal pain in a young girl.
The case of a 6-year-old girl with right lower quadrant pain is presented. For several days, she had experienced pain that worsened and then was accompanied by vomiting and low-grade fever. Acute appendicitis was considered, but at laparotomy she was found to have a necrotic, torsed ovary. The natural history, clinical presentation, and diagnostic features of ovarian torsion are reviewed.
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Accurate diagnosis and a clear management approach are the most important considerations in caring for behaviorally disordered emergency department patients. Treating behavioral emergencies often precedes an accurate diagnosis. ⋯ Behavioral emergencies usually requiring minimal pharmacological intervention include adjustment disorder, acute grief, rape and assault, and borderline personality disorder. Behavioral emergencies requiring maximal pharmacological intervention include assault, agitated psychosis, exacerbation of bipolar disorder, exacerbation of schizophrenia, brief reactive psychosis, delirium, dementia, substance withdrawal, and substance intoxication accompanied by violent behavior.