Articles: trauma.
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The aim of this study was to evaluate the safety and efficacy of a new intravenous (IV) regular human insulin infusion (RHI) algorithm for glycemic control in critically ill patients with renal failure. ⋯ The new RHI algorithm improved patient safety by decreasing the prevalence of moderate hypoglycemia and eliminating severe hypoglycemia. The duration of glycemic control within the target BG range was decreased, but acceptable within a higher target BG ceiling.
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Fracture of the lateral process of the talus is a rare lesion commonly described in snowboarding injuries. Nevertheless, several conditions can lead to this injury, which is often misdiagnosed as a severe ankle sprain because of the difficulty in detecting it on standard radiographic views. Computed tomography is very helpful for the assessment of this injury. ⋯ In the 2 situations, we opted for an open reduction and internal fixation using 2.4-mm cannulated screws. Both patients were allowed walking with partial weightbearing with a walker boot (VACOped(®)) for 6 weeks. At 1 year, both showed a consolidated fracture and had regained their preinjury level of activity.
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Case Reports
The impracticality of MRI for the diagnosis of atypical penile fracture in the emergency setting.
We report the case of a patient who presented to the emergency department with a history suspicious for penile fracture without typical physical exam findings. A small penile fracture was present on MRI, but the diagnosis was missed, and surgery was withheld owing to this misinformation. Despite its technical accuracy, MRI may be impractical for the diagnosis of penile fracture in the emergency setting.
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Although the relationship between psychoactive substance use and injury is known, evidence remains conflicting on the impact of substance use on clinical outcomes after injury. We hypothesized that preinjury substance use would negatively impact clinical outcomes. ⋯ Females and those aged >45 y are less likely to receive BASs and UDSs. Differential screening that is biased may place patients at risk for receiving inadequate care.
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Pediatric emergency care · May 2014
Analysis of Infant Lumbar Puncture Success Rates: Sitting Flexed Versus Lateral Flexed Positions.
The primary objective was to determine whether the sitting flexed position yields higher success rates of obtaining cerebrospinal fluid (CSF) for culture. The secondary objectives were to determine whether the sitting flexed position yields higher success rates of obtaining the following: CSF for cell count, non-traumatic CSF, and CSF on the first attempt. ⋯ The sitting flexed position was as successful as the lateral flexed position in the primary objective of obtaining CSF for culture and the secondary objectives of obtaining CSF for cell count and non-traumatic CSF. For the secondary objective of obtaining CSF on the first attempt, the sitting flexed position was associated with a higher rate of obtaining CSF on the first attempt in infants younger than 12 months.