J Emerg Med
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Randomized Controlled Trial
A Randomized, Placebo-Controlled Study of Intranasal Fentanyl as an Analgesic Adjunct For Incision and Drainage of Abscess.
Incision and drainage (I&D) of abscesses is one of the most painful procedures performed in emergency departments (EDs). ⋯ In this small study, the addition of intranasal fentanyl did not substantially impact the pain scores of ED patients undergoing I&D.
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Review Case Reports
A Prolonged QTc Interval Leads to the Diagnosis of Hyperthyroidism in an Adolescent Boy.
Syncope is a common cause of pediatric emergency department visits and carries a broad differential diagnosis, which includes a few rare but critical cardiac conditions. ⋯ We review the case of an adolescent boy who presented to the emergency department after a syncopal event. He was found to have a prolonged QTc interval on electrocardiogram (ECG), without personal or family history or known risk factors. He was screened for thyroid dysfunction on a second ED visit for presyncope and was subsequently diagnosed with hyperthyroidism. The patient was treated with methimazole for 2 weeks and a repeat ECG showed normalization of the QTc interval with a QTc reduction of more than 100 ms; routine thyroid studies showed correction of thyroid stimulating hormone and free thyroxine levels shortly thereafter. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case and review of the medical literature should raise awareness for the emergency physician to consider evaluation of thyroid function in pediatric patients with QT interval prolongation and vice versa, potentially averting dangerous dysrhythmias.
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Fishhook injuries are an uncommon trauma, and removing a penetrating fishhook is a complicated maneuver, especially if the wound involves delicate anatomical structures like the ocular region. ⋯ Emergency physicians should be aware of all the possible approaches to fishhook penetrating injuries. If the fishhook does not involve the globe and an ophthalmologist is not available, the injury may be managed in the emergency department.