The American journal of emergency medicine
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Letter Case Reports
No QT interval prolongation associated with quetiapine overdose.
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Review Case Reports
Tracheal rupture complicating emergent endotracheal intubation.
Tracheal rupture is rare in clinical practice. We present 2 female patients with tracheal rupture after emergent endotracheal intubation from different injury mechanisms; penetrating injury of using stylet during intubation in one case and overinflation of cuff of the endotracheal tube under rapid sequence intubation in another. ⋯ In our report, reconstructive 3-dimensional computed tomography scrupulously detected the rupture sites and provided the noninvasive modality for diagnosis. We review the literature of tracheal rupture after emergent endotracheal intubation in respects of the diagnosis, the possible mechanisms of the injury, and suggest strategies of management.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cosmetic outcomes of facial lacerations repaired with tissue-adhesive, absorbable, and nonabsorbable sutures.
The objective of this study was to compare the 9- to 12-month cosmetic outcome of facial lacerations closed with rapid-absorbing gut suture (RG), octylcyanoacrylate (OC), or nylon suture (NL). We hypothesized that no important differences would exist between these methods. This prospective, randomized study enrolled consecutive patients with facial lacerations when experienced physician assistants were on duty for wound closure. ⋯ Nine-month follow up occurred in 84 patients. The maximum difference within each evaluator's set of scores was 3.6 mm, well below the minimum clinically important difference (MCID) of 10 to 15 mm. We did not detect clinically important differences in cosmetic outcome at 9 to 12 months in patients with facial lacerations closed with RG, OC, or NL, although RG or OC could be preferred to eliminate follow-up visits for suture removal.
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Multicenter Study
Ability of CT to alter decision making in elderly patients with acute abdominal pain.
The study objective was to assess the ability of computerized tomography (CT) to alter clinical decision-making in the evaluation of elderly Emergency Department (ED) patients with abdominal pain. A prospective, observational cohort study of a convenience sample of ED patients, 65 years of age, with abdominal or flank pain of 1-week duration was conducted. ED attending physicians completed a structured data collection instrument recording 5 primary endpoints before and after CT. ⋯ The proportion of cases in which physicians reported a high degree of certainty in the suspected diagnosis increased from 36% pre-CT (95%CI 26,44%) to 77% post-CT (95% CI 69, 85%). Diagnosis and disposition were altered by CT in about one-half and one-quarter of patients, respectively, concurrent with a doubling in diagnostic certainty. CT has the ability to significantly alter clinically important decisions in elderly patients with abdominal pain.