The American journal of emergency medicine
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Review Case Reports
Orthopedic pitfalls in the ED: radiographically occult hip fracture.
Acute hip fracture is among the most commonly encountered orthopedic injuries seen by the emergency physician. The majority of these fractures can be readily diagnosed on the basis of clinical findings and plain radiographs. ⋯ The emergency physician needs to remain vigilant for this potential orthopedic pitfall. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.
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Researchers and clinicians have been investigating and implementing various methods of early diagnosis for sepsis before documentation of infection. The aim of this study was to outline the efficiency of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell count (WBC) in determining the early diagnosis of sepsis in the emergency department. Between January 1999 and September 2000, 34 patients with signs of systemic inflammatory response syndrome (SIRS) were enrolled in the study. ⋯ PCT values were compared with WBC and CRP levels. Predictive accuracy for sepsis expressed as area under the receiver operating characteristic (ROC) curve was.88 for PCT,.44 for WBC, and.34 for CRP. PCT can probably be used as a predictive marker in bacterial infections in emergency departments.
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Comparative Study
Gender differences in narcotic-induced emesis in the ED.
Narcotic analgesia is commonly given in the emergency department. Narcotic-induced nausea and vomiting is thought to be a common occurrence, but the gender incidence and associations are not well defined. The aim of this study was to document the sex-related complication of nausea and vomiting after opiate administration for pain relief in the ED. ⋯ A significant number of patients became nauseated and/or vomited from Emergency Department-administered narcotics. The nausea and vomiting was associated with female sex and the cause of pain. A comparative study of other pain medications versus narcotics for incidence of induced nausea and emesis would be useful.
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Resuscitative measures are traditionally undertaken for most patients with cardiac arrest, unless an advance directive exists. This long-standing default presumption of patients' wishes to undergo resuscitation has never been proven. This study was undertaken to determine societal preferences of the general public regarding resuscitation. ⋯ This study shows a trend in personal opinion among the general public toward refusal of resuscitative efforts in clinical scenarios with poor prognoses. Because so few patients have completed advance directives, physician awareness of such public opinions may be useful in decision-making in end-of-life care, particularly when caring for patients without advance directives. These public opinions support the feasibility of establishing societal consensus regarding resuscitation preferences, which may be useful in the development of federal and local guidelines and policies.
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Patients are commonly referred to the emergency department (ED) by family physicians (FPs). This study was undertaken to determine the outcome of these referred patients. A prospective cohort study of 196 patients referred by FPs to the ED of an urban, tertiary referral center was performed. ⋯ Family physicians are quite selective in their referrals to the ED. There is a high rate of admission and specialist consultation for referred patients. The vast majority of patients who are referred receive at least 1 investigation or intervention in the ED, and most referrals are appropriate.