The American journal of emergency medicine
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Transnasal butorphanol (TNB) is a mixed agonist-antagonist opioid that has recently been released for the treatment of painful conditions. Patients with a history of migraine diagnosed in either of two emergency departments (EDs) with a moderate or severe migraine were eligible for this prospective study. Patients received 1 mg of TNB at time zero and again in 45 minutes if needed. ⋯ Thirty-six percent experienced side effects, with all but 1 being mild or moderate. Seventy-five percent rated the treatment as good, very good, or excellent, and 71% would prefer to receive TNB for future migraines over other treatment options. TNB offers rapid, effective pain relief to the majority of ED migraine patients.
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Case Reports
Traumatic thrombophlebitis of the superficial dorsal vein of the penis: an occupational hazard.
Several cases of thrombophlebitis of the superficial dorsal vein of the penis (TSDVP) have been reported in the literature. Etiologies may include any of the following: trauma associated with vigorous sexual intercourse; penile strangulation caused by a multitude of entities; penile injection; infection; neoplasm; or surgery. We report a rare case of traumatic TSDVP in a cab driver following repeated injury to the penis by a coin-filled pouch. We review the etiologies, mechanism, and treatment of traumatic TSDVP, and attempt to identify men who may be at similar occupational risk.
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Case Reports
Spontaneous cervicothoracic epidural hematoma following prolonged valsalva secondary to trumpet playing.
Spontaneous spinal epidural hematoma is an uncommon clinical entity. Patients with this disease may present with devastating neurological deficits that can mimic other diseases. Emergency physicians should be familiar with this condition to assure appropriate therapy in a timely manner. A typical case of spontaneous spinal epidural hematoma is presented with review of appropriate differential diagnosis and management.
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An unusual case of multiple impalement by chain-link fence posts is presented in which facial, thoracic, and abdominal injuries were sustained following a rollover motor vehicle crash. Torso impalement injuries are briefly reviewed and guidelines for the management of such injuries are described.
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Comparative Study
Comparison of wound infection rates using plain versus buffered lidocaine for anesthesia of traumatic wounds.
Buffered lidocaine has been shown to be less painful than plain lidocaine for anesthetizing wounds. However, the effect of a buffering agent on the local host defenses has not been evaluated. The infection rates of wounds anesthetized with plain lidocaine versus buffered lidocaine were compared in an observational cohort study. ⋯ The infection rate for patients treated with plain lidocaine was 3.5%, versus that for patients treated with buffered lidocaine, 3.9% (P = .63). After adjustment for confounding variables, the infection rate did not differ between plain and buffered lidocaine. The infection rates of wounds repaired after anesthesia with either plain or buffered lidocaine are similar.