The American journal of emergency medicine
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A 4-week-old female infant presented to the emergency department (ED) due to a 1-week history of not moving her left lower extremity as well as crying during diaper changes. She had been seen 6 days prior at an ED, had normal x-rays, and was discharged home. The infant was afebrile and well appearing and had been feeding well all week. ⋯ Repeat x-rays showed a subtle distal tibial lucency, initially overlooked. The infant was admitted to the hospital and received a magnetic resonance imaging,which demonstrated distal tibial osteomyelitis with an accompanying ankle effusion. Cultures from the bone grew group B Streptococcus, and the infant received 6 weeks of antibiotic therapy.
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Randomized Controlled Trial
Forearm ultrasound-guided nerve blocks vs landmark-based wrist blocks for hand anesthesia in healthy volunteers.
Although ultrasound-guided regional nerve blocks have become more commonplace in the emergency department, there is no evidence to suggest that they are more effective than traditional landmark-based wrist blocks for hand anesthesia. We hypothesized that ultrasound-guided forearm nerve blocks would provide superior analgesia as compared with conventional landmark-based wrist blocks. ⋯ Ultrasound-guided forearm nerve blocks performed by an experienced operator result in more effective hand anesthesia than traditional anatomic landmark-based wrist blocks.
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Randomized Controlled Trial
The long spine board does not reduce lateral motion during transport-a randomized healthy volunteer crossover trial.
For thirty years, emergency medical services agencies have emphasized limiting spinal motion during transport of the trauma patient to the emergency department. The long spine board (LSB) has been the mainstay of spinal motion restriction practices, despite the paucity of data to support its use. The purpose of this study was to determine reduction in lateral motion afforded by the LSB in comparison to the stretcher mattress alone. ⋯ The stretcher mattress significantly reduced lateral movement during transport.
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Urinary tract infection (UTI) is a common cause of severe sepsis, and anatomic urologic obstruction is a recognized factor for complicated disease. We aimed to identify the incidence of urinary obstruction complicating acute septic shock and determine the characteristics and outcomes of this group. ⋯ Approximately 1 in 10 patients presenting with septic shock due to a urinary source is complicated by anatomic urinary obstruction. These patients have significantly higher mortality compared with patients without obstruction. Early imaging of patients with septic shock due to suspected urinary source should be considered to identify obstruction requiring emergency intervention.