European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Randomized Controlled Trial
Pronation versus supination maneuvers for the reduction of 'pulled elbow': a randomized clinical trial.
The purpose of this study was to compare the efficiency of the hyperpronation and supination-flexion maneuvers in the reduction of the pulled elbow. ⋯ Although final reduction rates were similar, the hyperpronation maneuver was more efficient at the first attempt, easier for physicians and less painful for the children.
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Comparative Study Clinical Trial
Minor head trauma and linear skull fracture in infants: cranial ultrasound or computed tomography?
To determine the clinical evolution of children with skull fractures as a result of a minor head trauma from a witnessed accidental fall that have been studied by transfontanellar ultrasound (TFUS). ⋯ TFUS is a valid and reliable alternative to CT for minor head trauma in infants with skull fractures. Its innocuousness and cost-effectiveness in comparison with CT makes it a good choice in this situation.
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In Sweden the public health system is subject of increasing budget problems. Medical training in Sweden does not yet focus on the cost aspects in patients diagnoses and treatment. ⋯ Generally cost awareness was considered low among all participating doctors. The level of experience seemed not to be related to better knowledge about prices. Younger doctors generally tended to underestimate the costs of investigation. Further education will be necessary to raise the level of cost awareness among hospital doctors.
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To determine if the serum levels of creatine kinase and myoglobin can be used to differentiate the grandmal tonic-clonic seizure and syncope activities in the emergency department (ED). ⋯ Serum creatine kinase measured at the fourth hour of loss of consciousness may be a potentially useful laboratory test to differentiate tonic-clonic seizure from syncope. Patently, it requires and warrants further study.
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We report a 54-year-old lady who presented to the emergency department for stridor and shortness of breath of acute onset. Nasopharyngoscopy revealed subglottic swelling and plain radiographs revealed a classical 'steeple sign' typical of croup. Although rare, croup should be considered in an adult presenting with stridor to the emergency department and the emergency airway team should be notified in advance for possible surgical airway emergency tracheostomy.