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
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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A study was conducted to determine the accuracy of tympanic thermometers for measuring the temperature of warmed fluids in fluid bags and in tubing at the delivery site (ie, beside the intravenous [IV] catheter). One-liter 0.9% saline bags were warmed in a microwave oven. A thermocouple electronic temperature probe was then used to measure the reference temperature. ⋯ Again, small differences were found on the order of 1 degree C. It was concluded that infrared thermometry is an accurate method for measuring the initial and delivery temperature of warmed fluids. Although tympanic thermometer measurements were statistically different from reference readings in certain temperature ranges, these differences were small and not clinically significant.(ABSTRACT TRUNCATED AT 250 WORDS)
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Patterns of utilization of emergency medical services transport (EMS) by the elderly are poorly understood. We determined population-based rates of EMS utilization by the elderly and characterized utilization patterns by age, gender, race, and reason for transport. This observational, population-based study was conducted in Forsyth County, NC, a semi-urban county served by one convalescent ambulance service and one EMS service. ⋯ Transport rates increased for successively older five-year age groups, demonstrating a 5.7-fold stepwise increase from ages 60-65 to 85+ (51/1,000 to 291/1,000). There was no difference in mean age between patients who were frequent EMS users (more than three transports during the year) (n = 66) and other elderly transportees. Reasons for transport differed little between those 60 to 84 years of age and those 85 years of age and older with the exception of chest pain, cardiac arrest, and seizures, all of which were significantly more prevalent in the younger age group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Despite widespread use of the Trendelenburg position, its autotransfusion effect remains controversial. Additionally, its adverse effect on cerebral circulation is not generally appreciated. The effects of a 10 degrees head-down tilt on central hemodynamics and flow through the internal jugular vein (IJV) were examined in ten healthy volunteers. ⋯ As a result, calculated IJV blood flow was unchanged throughout the period of tilt. Therefore, the mild trendelenburg position produces a transient autotransfusion effect in normovolemic patients. Our data also suggest that the Trendelenburg produces no adverse effect on cerebral circulation in patients with normal cerebral autoregulation.