The American journal of emergency medicine
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Randomized Controlled Trial
Ethyl chloride spray, a local anesthetic in arterial blood gas sampling: A randomized, controlled, double-blinded study.
Arterial blood gas sampling provides useful information on respiratory parameters and acid-base balance. However, this procedure is painful and uncomfortable for the patient. Therefore, this study aimed to examine the analgesic efficacy of ethyl chloride spray compared to a placebo during radial artery blood gas sampling. ⋯ Ethyl chloride spray has analgesic efficacy in arterial blood gas sampling. Therefore, the use of this spray provides an analgesic effect on patients during arterial blood gas sampling performed in the emergency department.
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Comment Letter Meta Analysis
Comment on "Effectiveness and safety of tranexamic acid in pediatric trauma: A systematic review and meta-analysis".
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Case Reports
Exceptional survival of an airplane stowaway, treated successfully with hyperbaric oxygen.
Survival of airplane stowaways is rare. Here we report an exceptional case of successful treatment and full recovery. After a transcontinental flight an unconscious stowaway was discovered in a wheel well of a Boeing 747-400F. ⋯ The presented patient survived an eight-hour exposure to calculated barometric pressures as low as 190 mmHg and ambient PO2 of 40 mmHg. Apart from creating awareness of this rare patient category, we want to stress the risk of altitude DCS in unpressurized flights. When DCS is suspected, immediate high-flow oxygen therapy should be initiated, followed by HBOT at the earliest opportunity.
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Spontaneous hemorrhage is a known risk for patients on anticoagulation therapy. Most previous spontaneous airway hemorrhage cases reported involve warfarin, and of the few that involved a direct oral anticoagulant, none involved the epiglottis. The following case describes a spontaneous epiglottic hematoma in a patient one week after starting a direct oral anticoagulant. ⋯ The patient received medical management including rivaroxaban reversal, steroids, and broad-spectrum antibiotics, but no airway management was deemed necessary. After close monitoring, the patient was discharged on hospital day two. Further research and risk profiling could benefit patients and emergency clinicians when considering spontaneous hemorrhage in the airway in patients taking a direct oral anticoagulant.