J Emerg Med
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The purpose of this study was to describe the violence experienced by Emergency Department (ED) workers from patients and visitors during the 6 months before the survey. Two hundred forty-two employees at five hospitals who came in direct contact with patients or visitors completed a survey. The study found that most workers had been verbally harassed by patients or visitors at least once. ⋯ There were significant relationships among violent experiences, feelings of safety, and job satisfaction. ED workers are at high risk for violence, and efforts are needed to decrease the incidence of violence. Such efforts are likely to have a positive impact on job satisfaction and retention of ED workers.
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Review Case Reports
Injury pattern of the Flash-Ball, a less-lethal weapon used for law enforcement: report of two cases and review of the literature.
Less-lethal weapons are used in law enforcement to neutralize combative individuals and to disperse riot crowds. Local police recently used such an impact weapon, the Flash-Ball, in two different situations. This gun fires large rubber bullets with kinetic energies around 200 J. ⋯ The medical literature on injuries induced by less-lethal impact weapons is reviewed. Impacts from the Flash-Ball can cause significant injury to internal organs, even without penetration. Investigations as for other high-energy blunt traumas are called for in these cases.
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The management of an agitated, abusive or violent patient is a common and challenging problem in Emergency Medicine. Priorities include measures to ensure the safety of the patient and the emergency staff, including provision of physical restraint of the patient and evaluation for correctable medical causes of such behavior. ⋯ The atypical antipsychotic agents may have fewer short-term side effects than older typical antipsychotic agents, such as haloperidol and droperidol. Currently available atypical antipsychotic medications for the treatment of acute agitation include ziprasidone and olanzapine, which can be administered in an intramuscular formulation, and risperidone, which is available in a rapidly dissolvable tablet and liquid formulation.
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Comparative Study
The Pittsburgh Decision Rule: triage nurse versus physician utilization in the emergency department.
The Pittsburgh Decision Rule (PDR) is a rule for ordering knee radiographs in patients with acute knee injuries. This study was designed to compare the utilization of the PDR between triage nurses and physicians. Consecutive patients presenting to the Emergency Department were enrolled. ⋯ Four of 13 fractures (31%) would have been missed using the PDR, resulting in a sensitivity of 77% for both physicians and nurses, and a specificity of 57% for physicians and 58% for nurses. Triage nurses and physicians were able to apply the PDR to patients who presented with acute knee injuries with a high level of agreement. However, the PDR demonstrated poor sensitivity in this patient population.
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Hematoma blocks with lidocaine are routinely utilized in the Emergency Department to allow reduction of Colles' fractures. Lidocaine toxicity is a potential complication of this procedure. We present a case report of a patient who developed acute mental status changes and generalized seizure immediately following administration of lidocaine during a hematoma block. The rapid onset of seizure development following injection was most likely due to inadvertent intravascular administration.