The American journal of emergency medicine
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Accurate diagnosis and a clear management approach are the most important considerations in caring for behaviorally disordered emergency department patients. Treating behavioral emergencies often precedes an accurate diagnosis. ⋯ Behavioral emergencies usually requiring minimal pharmacological intervention include adjustment disorder, acute grief, rape and assault, and borderline personality disorder. Behavioral emergencies requiring maximal pharmacological intervention include assault, agitated psychosis, exacerbation of bipolar disorder, exacerbation of schizophrenia, brief reactive psychosis, delirium, dementia, substance withdrawal, and substance intoxication accompanied by violent behavior.
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Comparative Study
Clinical impact of radiograph misinterpretation in a pediatric ED and the effect of physician training level.
Radiograph interpretation in the pediatric emergency department (ED) is commonly performed by pediatric emergency medicine (PEM) attendings or physicians-in-training. This study examines the effect of physician training level on radiograph interpretation and the clinical impact of false-negative radiograph interpretations. Data were collected on 1,471 radiographs of the chest, abdomen, extremity, lateral neck, and cervical spine interpreted by PEM attendings, one PEM fellow, one physician assistant, and emergency medicine, pediatric and family practice residents. ⋯ Twenty (1.4%) radiographs had clinically significant (false-negative) misinterpretations, including 1.7% of physician-in-training and 0.8% of attending interpretations (P = 0.15). No morbidity resulted from the delay in correct interpretation. Radiograph misinterpretation by ED physicians occurs but is unlikely to result in significant morbidity.
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Review Case Reports
Ovarian torsion: an unusual cause of abdominal pain in a young girl.
The case of a 6-year-old girl with right lower quadrant pain is presented. For several days, she had experienced pain that worsened and then was accompanied by vomiting and low-grade fever. Acute appendicitis was considered, but at laparotomy she was found to have a necrotic, torsed ovary. The natural history, clinical presentation, and diagnostic features of ovarian torsion are reviewed.
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Paraphimosis occurs when the foreskin of the penis is retracted over the glans and cannot be replaced in its normal position. The tight ring of preputial skin constricts the distal penis causing vascular occlusion, much like a tourniquet. ⋯ Irreducible paraphimosis is treated by dorsal slit procedure and subsequent circumcision. We present two cases illustrating the treatment techniques and possible complications of paraphimosis in men.