Emergency medicine journal : EMJ
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Rickets in early childhood has been well documented in the literature. We present a case report on a teenage Somalian boy who had a generalised tonic clonic fit (an unusual presentation of rickets in late childhood) and was diagnosed with vitamin D deficient rickets.
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A short cut review was carried out to establish whether epinephrine (adrenaline) is safe to use in digital nerve blocks. A total of 16 papers were found using the reported search, of which seven represented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are presented in table 2. The clinical bottom line is that epinephrine (1:200 000 to 1:100 000) is safe to use in digital blocks.
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Case Reports
Are computed tomography scans adequate in assessing cervical spine pain following blunt trauma?
Good quality three-view radiographs (anteroposterior, lateral, and open-mouth/odontoid) of the cervical spine exclude most unstable injuries, with sensitivity as high as 92% in adults and 94% in children. The diagnostic performance of helical computed tomography (CT) scanners may be even greater, with reported sensitivity as high as 99% and specificity 93%. ⋯ This case involves a patient with an unstable cervical spine injury whose cervical subluxation was only detected following use of dynamic radiographs, despite a prior investigation with helical CT. In this way, the use of dynamic radiographs following blunt cervical trauma should be considered an effective tool for managing acute cervical spine injury in the awake, alert, and neurologically intact patient with neck pain.
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Case Reports
Benign surgical emphysema of the hand and upper limb: gas is not always gangrene--a report of two cases.
Subcutaneous emphysema of the hand can result from benign causes. Differentiating this from emphysema caused by gas-forming organisms is essential in the acute stages of presentation as the management differs considerably. We present two cases of benign surgical emphysema and highlight the importance of distinguishing between this and gas gangrene. A considered history and the absence of systemic features associated with benign causes of subcutaneous air will prevent unnecessary surgical exploration.