The American journal of emergency medicine
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Case Reports
Diffusion-weighted MRI of intracerebral hemorrhage clinically undifferentiated from ischemic stroke.
This report describes diffusion-weighted MRI findings of some intracerebral hemorrhages clinically undifferentiated from ischemic stroke. We treated patients with characteristic features of intracerebral hemorrhages that could distinguish themselves from ischemic lesion on diffusion-weighted imaging. Therefore, we think diffusion-weighted imaging could be an emergency screening tool for ischemic stroke as an alternative to computed tomography, and the EP should be familiar with the diffusion-weighted imaging findings of intracerebral hemorrhage as well as cerebral infarction.
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Hazardous materials (hazmat) events pose a health threat not only for those individuals in the immediate vicinity of the release (ie, members of the general public, on-site first responders, employees), but also for ED personnel (ie, physicians and nurses) treating the chemically contaminated victims arriving at the hospital. Secondary contamination injuries to ED personnel result when exposed victims enter the ED without being properly decontaminated. ⋯ The predominant injuries sustained were respiratory and eye irritation. Proper victim decontamination procedures, good field-to-hospital communication, and appropriate personal protective equipment (PPE) use can help prevent ED personnel injuries and contamination of the ED.
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Letter Case Reports
Primary hyperparathyroidism: acute paranoid psychosis.
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Randomized Controlled Trial Comparative Study Clinical Trial
Minimum clinically significant VAS differences for simultaneous (paired) interval serial pain assessments.
We conducted two studies to determine whether the minimum clinically significant difference in the visual analog scale (VAS) for nearly simultaneous and brief-interval serial assessments of pain is less than that for pain assessment at 20- to 30-minute intervals, using a 10-cm VAS. The first study was a blinded, randomized, placebo-controlled paired trial comparing the pain of intravenous cannulation in both hands (20-minute application of a eutectic mixture of local anesthetics v placebo) of study subjects. The second study was a non-blinded, randomized, paired trial of different treatments for jellyfish stings. ⋯ On the basis of these findings, the minimum clinically significant VAS difference for paired comparisons that are simultaneous or occur within 5 minutes of each other is about 0.5 cm or less. This value is less than the 1.3-cm value determined for serial 20- to 30-minute pain comparisons. It is likely that other types of pain comparisons may have different minimum clinically significant VAS differences.