Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Case Reports
Left bundle branch block pattern complicating the electrocardiographic evaluation of acute myocardial infarction.
The ECG diagnosis of ischemic heart disease is made more difficult in the setting of left bundle branch block (LBBB). The ECG diagnosis of prior or remote myocardial infarction (MI) is extremely difficult in this setting. ⋯ Several strategies are available to the emergency physician (EP) to assist in the correct interpretation of this ECG pattern, including: a knowledge of the anticipated ST-segment--T-wave changes of LBBB and, consequently, the ability to recognize ischemic morphologies; the performance of serial ECGs demonstrating dynamic changes encountered in ischemic patients; and a comparison with previous ECGs. Three cases are reported in which an analysis of the 12-lead ECG in the setting of LBBB assisted the EP in establishing the correct diagnosis of acute MI and applying timely, appropriate therapy.
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Randomized Controlled Trial Clinical Trial
Evaluation of ketorolac in children with forearm fractures.
To evaluate ketorolac for pain relief and an opioid-sparing effect in children with forearm fractures necessitating reduction. ⋯ Although ketorolac seems to add to patient comfort in children with forearm fractures, it does not have a significant opioid-sparing effect. Ketorolac showed a trend toward pain relief, but statistical significance was not reached.