The American journal of emergency medicine
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The purpose of this study was to describe the prevalence of significant intraocular sequelae (SIOS) and its correlation with the severity of blunt orbital trauma. Four hundred ten consecutive patients presenting to the ED who had sustained blunt orbital trauma were studied. The severity of orbital trauma was graded and SIOS was determined by the presence of an intraocular injury as listed in Table 2. ⋯ In the severe group, the presence of SIOS was detected in 8 (23.5%) blowout fractures and in 12 (35.3%) non-blowout fractures. In view of the high rates of ocular complications among mild and moderate orbital injuries, such patients should have prompt ophthalmic follow up. The relatively low prevalence of SIOS in patients with severe orbital trauma could suggest a protective mechanism in this type of injury.
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This study was undertaken to test the hypothesis that patients transferred between hospitals with a dislocated hip have a greater incidence of sciatic nerve injury than patients who have their hip reduced at the first facility. One hundred six dislocated hips were included in this 12-year retrospective study. Sixty-nine hips were relocated at the first hospital and 36 patients were transferred with the hip still dislocated to LDS Hospital. ⋯ Time to relocation was significantly longer in patients with major motor nerve injury (P =.016). The presence of an associated fracture had no influence on sciatic nerve injury rates. The length of time a hip remains dislocated influences the incidence and severity of major sciatic nerve injury.
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Case Reports
Additional electrocardiographic leads in the ED chest pain patient: right ventricular and posterior leads.
In the evaluation of the patient with chest pain, the 12-lead electro cardiogram is a less-than-(ECG) perfect indicator of acute myocardial infarction (AMI), particularly when used early in the course of the acute ischemic event; this relative insensitivity for AMI results from many different issues, including a less-than-optimal imaging of certain areas of the heart. It has been suggested that the sensitivity of the 12-lead ECG can be improved if 3 additional body surface leads are used in selected individuals. ⋯ The standard ECG coupled with these additional leads constitutes the 15-lead ECG, the most frequently used additional lead ECG in clinical practice. The use of the additional leads might not only confirm the presence of AMI, but also provide a more accurate reflection of the true extent of myocardial damage.