The American journal of emergency medicine
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Multicenter Study Observational Study
Intranasal fentanyl and inhaled nitrous oxide for fracture reduction: The FAN observational study.
Procedural sedation and analgesia (PSA) are frequently used for fracture reduction in pediatric emergency departments (ED). Combining intranasal (IN) fentanyl with inhalation of nitrous oxide (N2O) allow for short recovery time and obviates painful and time-consuming IV access insertions. ⋯ PSA with IN fentanyl and N2O is effective and safe for the reduction of mildly/moderately displaced fracture or dislocation, and has a high satisfaction rate.
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Clinical Trial
Utility of point of care assessment of platelet reactivity (using the PFA-100®) to aid in diagnosis of stroke.
Rapid and accurate diagnosis of patients presenting with symptoms of stroke is needed to facilitate the timely delivery of proven effective treatment for patients with acute ischemic stroke (AIS). The aim of this study was to determine whether early assessment of platelet reactivity in patients presenting with symptoms of AIS was associated with a diagnosis of AIS, transient ischemic attack (TIA), or stroke mimic. ⋯ Closure time was not found to be a clinically reliable differentiator of patients with a diagnosis of AIS, TIA, or stroke mimic in the ED.
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Non-traumatic cardiac arrest is a major public health problem that carries an extremely high mortality rate. If we hope to increase the survivability of this condition, it is imperative that alternative methods of treatment are given due consideration. Balloon occlusion of the aorta can be used as a method of circulatory support in the critically ill patient. ⋯ Animal research has demonstrated improvements in cerebral and coronary perfusion pressure during ACLS that lead to statistically significant differences in mortality. Several case series in humans have replicated these findings, suggesting the efficacy of this procedure. The objectives of this review are to: 1) introduce the reader to REBOA 2) review the physiology of NTCA and examine the current limitations of traditional ACLS 3) summarize the literature regarding the efficacy and feasibility of aortic balloon occlusion to support traditional ACLS.
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Numb chin syndrome (NCS) is a rare yet potentially ominous sensory neuropathy in the distribution of the mental or inferior alveolar nerve characterized by unilateral hypoesthesia over the lower lip, chin and occasionally gingival mucosa. Recognizing NCS is clinically important as this may be a subtle sign of occult malignancy progression or heralding the relapses. ⋯ Current expert opinion is that patients with NCS without apparent cause should be assumed to have a malignant etiology until proven otherwise Lossos and Siegal (1992) [1]. Here we report a relapse of Non-Hodgkin lymphoma with NCS with no evidence of metastasis.
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We present an acute apixaban overdose without reported coingestants; it is the first such case report associated with multiple serum drug levels to assist in determining overdose kinetics. A 62 year old female presented to an emergency department (ED) 2 hours after ingesting sixty 5 mg tablets (5mg/kg) of her spouse's apixaban medication. She denied coingestants, and did not take her prescribed medications that day. ⋯ There was no utilization of blood products or factor replacement. There was never any bleeding, and her hemoglobin did not decrease. This case demonstrates that a single ingestion of apixaban can occur without any complications occurring.