The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
The efficacy of tepid sponge bathing to reduce fever in young children.
Tepid sponge baths distress febrile children, and their efficacy at reducing fever has not been established. This study compared fever reduction and with (1) acetaminophen alone and (2) acetaminophen plus a 15-minute tepid sponge bath. Twenty children, ages 5 to 68 months, who presented to the emergency department or urgent care center with fever of > or = 38.9 degrees C were randomized to receive (1) acetaminophen alone or (2) acetaminophen plus a 15-minute tepid sponge bath. ⋯ Subjects were monitored for signs of discomfort (crying, shivering, goosebumps). Sponge-bathed subjects cooled faster during the first hour but there was no significant temperature difference between the groups over the 2-hour study period (P = .871). Subjects in the sponge bath group had significantly higher discomfort scores (P = .009).
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The emergency physician must be aware of the varied ways in which epiglottitis can present. This report discusses two adult patients who presented with symptoms and signs indicative of uvulitis who were found to have associated epiglottitis. ⋯ Management consisted of close observation and treatment with an intravenous antibiotic and corticosteroid. The emergency physician should consider the possibility of coexistent epiglottitis in the adult patient who presents with uvulitis.
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Acute pyelonephritis is a clinical syndrome that can be confused with other conditions. To investigate this problem, a retrospective cohort study was conducted using two mutually exclusive sets of clinical criteria for acute pyelonephritis in women 15 years of age or older who presented to the emergency department of a university hospital. All patients had pyuria, and one group had documented fever (temperature of > or = 37.8 degrees C) while the other group had a temperature of < 37.8 degrees C but had other evidence of possible upper tract infection. ⋯ Other diagnoses included cholecystitis, pelvic inflammatory disease, and diverticulitis. The positive predictive value of the definition of pyelonephritis in the febrile group was 0.98, and it was 0.84 for the afebrile group. Physicians examining patients with clinical evidence of acute pyelonephritis but without objective fever should be alert for alternative diagnoses.
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A case of right bronchial rupture demonstrated by computed tomography (CT) is reported. Chest radiographs of a 55-year-old man who sustained blunt chest trauma showed bilateral pneumomediastinum, hydropneumothorax, and subcutaneous emphysema with fracture of the left 3rd and 4th ribs. ⋯ Bronchoscopy and thoracostomy confirmed the CT findings and the patient was treated by bronchorrhaphy with end-to-end anastomosis. The airway should be meticulously evaluated in cases of mediastinal and subcutaneous emphysema, especially after trauma.
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Letter Case Reports
Tramadol overdose requiring prolonged opioid antagonism.