The American journal of emergency medicine
-
Randomized Controlled Trial
Nebulized fentanyl vs intravenous morphine for ED patients with acute abdominal pain: a randomized double-blinded, placebo-controlled clinical trial.
Patients with acute abdominal pain commonly present to emergency departments. The safe and effective relief of discomfort is a concern to patients and physicians. Intravenous opioids are the traditional method used to provide pain relief in this setting, but intravenous access is time consuming and not always achievable. ⋯ There were no adverse effects noted in the NF group. Both patient and physician satisfaction scores were higher in the NF group. Fentanyl citrate at a dose of 2 μg/kg through a breath-actuated nebulizer appears to be a feasible and safe alternative to IVM (0.1 mg/kg) in the treatment of acute abdominal pain.
-
Review Case Reports
Traumatic pneumorrhachis: 2 cases and review of the literature.
The presence of air in the spinal canal is known as pneumorrhachis (PNR), aerorachia, intraspinal pneumocele, pneumosaccus, pneumomyelogra, or intraspinal air. Pneumorrhachis may be iatrogenic, traumatic, and nontraumatic. We treated 2 patients who had posttraumatic PNR in the cervical spine region after stab injuries. ⋯ Muscle strength improved. In summary, PNR is a rare condition that usually is treated nonoperatively. However, surgical treatment may be indicated for persistent neurologic symptoms or signs; the air detected in the spinal canal with radiographic imaging may be associated with an active cerebrospinal fluid leak and may cause spinal compression.
-
Randomized Controlled Trial Comparative Study
Comparison of the efficacy of diclofenac, acupuncture, and acetaminophen in the treatment of renal colic.
The objective is to compare the analgesic effects of diclofenac, acetaminophen, and acupuncture in urolithiasis-driven renal colic pain relief. ⋯ In renal colic patients with a possible nonsteroidal anti-inflammatory drug and acetaminophen side effect risk, acupuncture emerges as an alternative treatment modality.
-
The objectives of our investigation were to review the evidence for the efficacy and safety of carotid sinus massage in terminating supraventricular tachycardia and to determine if other potentially less harmful interventions have been established to be safer and more effective. ⋯ Based on the limited evidence available, we believe that carotid sinus massage should be reconsidered as a first-line therapeutic intervention in the termination of SVT.
-
Case Reports
Iliopsoas abscess associated with endovascular infection: an acute case of chronic Q fever.
fever is a zoonosis caused by Coxiella burnetii, which occurs worldwide. After acute Q fever infection, 1% to 5% of patients develop chronic Q fever. ⋯ The diagnosis and localization of chronic Q fever are challenging, as most patients present with nonspecific symptoms. Moreover, it often occurs in patients without a known episode of acute infection.