The American journal of emergency medicine
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Comparative Study
Evaluation of intramuscular fosphenytoin vs intravenous phenytoin loading in the ED.
A comparison of length of stay in an emergency department (ED) after loading patients at risk for seizures with either intravenous (IV) phenytoin or intramuscular (IM) fosphenytoin was studied. ⋯ This study found that patients were discharged from the ED earlier with the loading of IM fosphenytoin compared to IV phenytoin.
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Some patients presenting to emergency departments (EDs) suffer from conditions requiring potentially painful treatment; procedural sedation and analgesia (PSA) are important components of their management. The purpose of this study was to determine the resources used during the administration of PSA. ⋯ Procedural sedation and analgesia are potentially time-consuming interventions requiring the coordination of ED staff; delays in procedures represent opportunities to reduce ED overcrowding. Procedural sedation and analgesia guidelines may assist with standardization.
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Randomized Controlled Trial
Short- vs long-axis approach to ultrasound-guided peripheral intravenous access: a prospective randomized study.
The objective of the study was to determine if the short-axis approach and long-axis approach to ultrasound-guided peripheral intravenous access (USGPIV) differ in success rate, catheter insertion time, and number of needle sticks. ⋯ Short-axis USGPIV technique required less insertion time than the long-axis technique. Success rate was higher in the short-axis group, but this difference was not statistically significant. However, all of the failed IVs in the long axis were rescued successfully in short axis.
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The objective of the study was to determine if hypothermia in pediatric trauma patients is associated with increased mortality. ⋯ Hypothermia is a risk factor for increased mortality in pediatric trauma patients. This pilot study warrants a more detailed, multicenter analysis to assess the impact of hypothermia in the pediatric trauma patient.
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Mexiletine is a class IB antiarrhythmic agent. Although it is primarily used in treating ventricular arrhythmias, recent indications for use of mexiletine include chronic and neuropathic pains. At high doses, mexiletine causes drowsiness, confusion, nausea, hypotension, sinus bradycardia, paresthesia, seizures, bundle branch block, atrioventricular heart block, ventricular arrhythmias, asystole, cardiovascular collapse, and coma. ⋯ Patient then underwent hemodialysis. His vital signs and overall condition improved rapidly following hemodialysis treatment. In this case report, we aimed to emphasize hemodialysis as a useful alternative therapy for severe mexiletine intoxications.