The American journal of emergency medicine
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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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Few studies have examined visits to hospital EDs and subsequent admission for the treatment of nontraumatic dental emergencies. The present study of Medicaid-eligible adults was conducted to gain a better understanding of the magnitude of this problem. Data tapes describing adult Medicaid patients' hospital ED and admission claims were obtained from the Maryland Medicaid Management Information System. ⋯ The mean total cost for claims associated with hospital admissions was $5793 US dollars, whereas the minimum cost was $949 and the maximum was $43,524 US dollars. Although the frequency of hospital admissions associated with nontraumatic dental emergencies is not great, a hospital admission is among the most extreme consequences of failing to prevent or treat dental problems. Although some hospital admissions related to dental problems could be unavoidable, further studies are needed to better understand mechanisms for reducing the use of EDs for care best provided in community-based dental offices.
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The objective of this study was too determine if patients can accurately read a visual analog scale (VAS) for pain. A 100-mm visual analog pain scale designed for patient use was printed on the top page of carbonless copy paper with a perfectly aligned hatched scale on the second (bottom) page. Patients over the age of 18 in acute pain were enrolled in this prospective, descriptive study. ⋯ One hundred thirty-eight (95.2%) read their VAS within +/-2 mm of physician readings. Ninety-five percent of patients are able to read a VAS within +/-2 mm of physician readings. The data suggests this instrument could be used by discharged patients in longitudinal pain studies or with help in management of chronic pain.
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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.