The American journal of emergency medicine
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Case Reports
High-velocity gunshot to the head presenting as initial minor head injury: things are not what they seem.
Tangential gunshots to the head are a special type of injury in which the bullet or bullet fragments do not penetrate the inner table of the skull. Most of patients experiencing this kind of injuries usually have a benign clinical presentation. ⋯ The characteristics of the wound and initial neurologic condition led to first contact physicians to treat this injury as a case of mild head trauma. This case shows us that gunshots to the head caused by high-velocity missiles must be treated aggressively like a severe head injury, even when the initial neurologic examination is normal.
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The Bayesian approach to disease diagnosis in the emergency department is facilitated by the use of likelihood ratios (LRs) to evaluate diagnostic tests. The use of dichotomous, interval, and joint LRs for single and multiple tests is reviewed, and comparison is made to regression modeling. The clinical motivation for a single statistic to describe the average change in the odds of disease associated with the use of a particular test or series of tests is described. ⋯ Application of both tests together to patients with wide QRS complex tachycardia changes the odds of ventricular tachycardia, on average, by a factor of 3.5 (95% confidence interval, 2.4-6.2). Challenges are described, and methods are provided to estimate the 95% confidence interval of the LR and AALR using bootstrapping techniques. The AALR is a test statistic that may be helpful for clinicians and researchers in evaluating and comparing diagnostic testing approaches.
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Painful extremity injuries are common patient complaints in resort clinics, urgent care clinics, and emergency departments. We hypothesized that intranasal (IN) sufentanil could provide rapid, noninvasive, effective pain relief to patients presenting with acute extremity injuries. ⋯ In this limited observational trial, IN sufentanil provided rapid, safe, and noninvasive pain relief to patients presenting with acute traumatic extremity injuries. Given the ease of administration, this may serve as a viable option for use in other settings, such as urgent care clinics and emergency departments.
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Postresuscitation myocardial dysfunction contributes to the low survival rate after successful resuscitation, but its mechanism remains poorly understood. This study investigated whether caspase 3-mediated apoptosis is activated in the heart after postresuscitation myocardial dysfunction. ⋯ Caspase 3-mediated apoptosis may be one of the main pathologic mechanisms of postresuscitation myocardial injury in a porcine model of CA.