The American journal of emergency medicine
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A case of gas gangrene that caused intractable shoulder pain refractory to narcotics in an immunocompromised host is presented. Gas gangrene has been associated with severe trauma involving penetrating wounds, compound fractures, extensive soft-tissue injury, intramuscular injection of epinephrine, and interruption of arterial blood supply. ⋯ The responsible organism was Clostridium septicum. Emergency medicine physicians must consider gas gangrene Clostridium infection in immunocompromised individuals without evidence of trauma who present with localized and intractable pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Oral labetalol versus oral nifedipine in hypertensive urgencies in the ED.
Therapy in hypertensive urgencies is debated and complicated by the side effects of available agents. In a prospective, randomized, open labeled study, the use of oral labetalol, an alpha- and beta-adrenergic blocker, with oral nifedipine in hypertensive urgencies in the emergency department was compared. Patients with diastolic blood pressures (DBP) of more than 120 mm Hg without criteria for a hypertensive emergency were eligible. ⋯ The pretreatment pressure for labetalol was 195/127 mm Hg and for nifedipine was 198/128 mm Hg (P > .2), which decreased to a posttreatment pressure for labetalol of 154/100 mm Hg and for nifedipine of 163/100 mm Hg (P > .2). The mean decrease in systolic (SBP)/DBP was 42.6/26.5 mm Hg with labetalol and 34.9/28.4 mm Hg for nifedipine (P > .2). No significant side effects occurred with either drug.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
The role of single ECG, creatinine kinase, and CKMB in diagnosing patients with acute chest pain.
The objective of this study was to determine the combined accuracy of emergency department (ED) cardiac enzymes and electrocardiograms (ECGs) in patients who were admitted to "rule-out" myocardial infarction (ROMI). A retrospective analysis of ED creatinine kinase (CK), CKMB, and ECG was performed and the results were compared with final hospital diagnosis of MI, in the ED of a medical school- and university hospital-affiliated teaching Veterans Affairs Medical Center. Approximately 222 consecutive ED patients admitted to ROMI, including 43 (19%) MI patients, 29 (67%) of whom presented to the ED within 24 hours of symptom onset were eligible to participate. ⋯ For all MI patients, regardless of duration of symptoms, more than half of the ED ECGs had new ST-T changes consistent with an acute MI or acute myocardial ischemia. In the MI patients who presented within 24 hours of symptom onset, 79% had positive enzymes or ECG or both in the ED. No statistically significant difference in the sensitivity rates for MI between the CK and CKMB comparing enzymes with ECGs was found.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
The shorthand vertical mattress stitch: evaluation of a new suture technique.
The shorthand vertical mattress suture is a new suture technique that provides the same amount of wound eversion in less time than the classic method. A randomized, prospective clinical trial was designed to test this hypothesis in a University-affiliated community hospital. Thirty patients who presented to the emergency department with traumatic lacerations requiring primary closure were eligible for this study. ⋯ The shorthand stitch provided the same amount of wound eversion in half the time as the classic technique. No infectious complications, delayed wound healing, or cosmetic problems were observed with the shorthand technique. The shorthand vertical mattress stitch described is an efficient, alternative method for laceration repair without compromising wound eversion or cosmetic results.