The American journal of emergency medicine
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Acute abdominal pain in children is encountered frequently, and the differential diagnosis is extensive. Acute ovarian torsion in children is rare, especially at a very young age, and a difficult diagnosis to make. Infarction caused by ovarian torsion will result if the twist is not unwound spontaneously or surgically in a timely fashion. ⋯ Because acute ovarian torsion in a very young child is not encountered frequently, timely diagnosis is required to prevent mortality and minimize morbidity. It is important to keep ovarian torsion in the differential of any female children with acute abdominal pain. Emergency physicians should be aware that the potential of acute ovarian torsion in a very young child has a high index of suspicion and seek early operative intervention.
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Multicenter Study Clinical Trial
Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest.
Therapeutic hypothermia (TH) improves the outcomes of cardiac arrest (CA) survivors. The aim of this study was to evaluate retrospectively the efficacy and safety of an immediate prehospital cooling procedure implemented just after the return of spontaneous circulation with a prehospital setting. During 30 months, the case records of comatose survivors of out-of-hospital CA presumably due to a cardiac disease were studied. ⋯ Rapid infusion of fluid was not associated with pulmonary edema. After 1 year of follow-up, 6 (27%) of 22 patients in the cooling group and 30 (39%) of 77 patients in the control group had a good outcome. Our preliminary observation suggests that in comatose survivors of CA, prehospital TH with infusion of large-volume, ice-cold intravenous saline is feasible and can be used safely by mobile emergency and intensive care units.
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Controlled Clinical Trial
Use of the Triage Stroke Panel in a neurologic emergency service.
Acute stroke is associated with serum elevations of numerous markers. We evaluated the additive accuracy of the Triage Stroke Panel (D-dimer, B-natriuretic peptide, matrix metalloproteinase 9, and S-100beta) to the triaging nurse for acute stroke diagnosis. ⋯ The Triage Stroke Panel provides objective information that complements a triage nurse in the assessment of a suspected stroke patient. Its performance compares favorably with that of a well-trained stroke center triage nurse, suggesting potential use in nonexpert centers for improving the accuracy of stroke diagnosis.
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Pyomyositis is an unusual but potentially serious disease in children. Staphylococcus aureus is the most commonly implicated pathogen, but pneumococcal pyomyositis is very rare. Clinical diagnosis of pyomyositis can be difficult often mimicking septic arthritis of the hip or appendicitis. ⋯ Blood cultures grew Streptococcus pneumoniae, sensitive to penicillin, ceftriaxone, and clindamycin. He was successfully treated with a 3-week course of clindamycin. Early recognition, appropriate antibiotic therapy, and if indicated, drainage of the muscle abscess is critical to reduce morbidity and mortality.
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The aim of this study was to establish the impact of patient sex on the provision of analgesia by paramedics for patients reporting pain in the prehospital setting. ⋯ Sex is not associated with the rate of paramedic-initiated analgesia, but is associated with differences in the type of analgesia administered.