J Emerg Med
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Elbow dislocations are one of the most common large joint dislocations and they require urgent reduction in the emergency department. Posterior dislocations are the most common type, with anterior dislocations occurring in rare cases. ⋯ It is important for emergency physicians to be familiar with several different reduction techniques for elbow dislocations in case the initial reduction attempt is unsuccessful. This article reviews the current evidence for reduction of elbow dislocations and any variations on these approaches.
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Multicenter Study
The Diagnosis of Concussion in Pediatric Emergency Departments: A Prospective Multicenter Study.
The accurate identification of children with a concussion by emergency physicians is important to initiate appropriate anticipatory guidance and management. ⋯ Relative to international criteria, the more selective assignment of concussion by emergency physicians was associated with a greater frequency of persistent concussion symptoms. In addition, while most children meeting international criteria for concussion were also provided this diagnosis for concussion by an emergency physician, the presence of 5 specific variables made this diagnosis more likely.
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Entrapment is a challenging and crucial factor in the prehospital setting. Few studies have addressed whether entrapment has an influence on on-scene treatment or on the following hospital course. ⋯ In polytraumatized patients, entrapment has a minor influence on the outcome and treatment in the prehospital and hospital setting when using physician-based air rescue. However, entrapped patients are prone to sustain more severe trauma to the extremities.
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Cholecystitis is an inflammation of the gallbladder that most commonly occurs as a result of obstruction of the cystic duct by gallstones. The current standard of treatment for acute cholecystitis is cholecystectomy. ⋯ Early laparoscopic cholecystectomy is preferred over delayed, due to overall better quality of life, lower morbidity rates, and lower hospital cost. Ultimately, management of acute cholecystitis by emergency physicians should be made based on patient's clinical status and available resources in their particular hospital.
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Observational Study
A Prospective Evaluation of the Influence of an Electronic Clinical Practice Guidelines on Concussion Patients' Future Activities and Outcomes.
Patients with mild traumatic brain injury or concussion commonly present to the emergency department for assessment; providing patients with information on usual symptoms and their progression may encourage faster recovery. ⋯ An eCPG handout improved patients' short-term outcomes; however, physician use and adherence to guideline recommendations was low. To further facilitate physician compliance and therefore patient recovery, barriers to use of the eCPG handout need to be identified and addressed.