J Emerg Med
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Comparative Study Clinical Trial
A beveled, conventional cutting edge surgical needle: a new innovation in wound closure.
A new beveled, conventional cutting edge needle has been developed with superior performance characteristics over those of other conventional cutting edge needles. It is composed of a unique stainless steel, ASTM 45500, that has been heat-treated after the curving process to enhance its resistance to bending. The angle of presentation of its cutting edges has been decreased to enhance needle sharpness. On the basis of the results of experimental and clinical investigations, this new needle is recommended for closure of lacerations.
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Radial head subluxation (RHS) produces no radiographic abnormalities according to most experts. However, recent anecdotal case reports have identified displacement of the radiocapitellar line (RCL) in pediatric patients with RHS. To verify this finding, we retrospectively reviewed all patients less than 5 years of age who received elbow and forearm radiographs in our emergency department. ⋯ The presence of RCL displacement without disruption of the radiocapitellar articulation confirms the diagnosis of RHS, but does not appear to change treatment or outcome in this subset of patients. In addition, radiographs may not be mandatory when the diagnosis of RHS is certain. We suggest obtaining radiographs if the history (i.e., fall) or physical examination is atypical or if reduction is unsuccessful to rule out more serious injuries such as radial head dislocation or fracture.
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A 28-year-old woman presented to the emergency department for treatment of a corneal abrasion. Shortly after inserting two drops of proparacaine hydrochloride eye drops into her conjunctival sac, she experienced a tonic-clonic seizure. The absorption, systemic effects, and side effects of topical ophthalmological preparations are discussed.
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Radial head subluxation (RHS) is a common pediatric orthopedic injury, frequently diagnosed through the classic history of axial traction to the upper extremity of a child. However, not all children with RHS will present with this classic history. This may result in misdiagnosis and delay of appropriate treatment. ⋯ The classic and nonclassic history groups were equivalent in patient age, spontaneous reductions, and physician reductions. A trend towards more radiographs was noted in the nonclassic group. This study suggests that even in the absence of the classic history of upper extremity traction, radial head subluxation should be suspected in any pediatric patient with an upper extremity complaint who presents with the affected arm in the nursemaid's position.