Articles: emergency-department.
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Emergency Department Identification and Critical Care Management of a Utah Prison Botulism Outbreak.
We report botulism poisoning at a state prison after ingestion of homemade wine (pruno). ⋯ A pruno-associated botulism outbreak resulted in respiratory failure and abnormal pulmonary parameters in the most affected patients. Electromyography abnormalities were observed in the majority of intubated patients. Potato in the pruno recipe was associated with botulism.
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Multicenter Study Observational Study
Extension Test and Ossal Point Tenderness Cannot Accurately Exclude Significant Injury in Acute Elbow Trauma.
Elbow injury is a common presentation at the emergency department (ED). There are no guidelines indicating which of these patients require radiography, whereas clinical decision rules for other limb injuries are widely accepted and resulted in less radiography and reduced waiting times. We aim to identify clinical signs that can be used to predict the need for radiography in elbow injury. ⋯ In contrast with previous studies, ours shows that in acute elbow injury, the extension test alone or in combination with point tenderness assessment does not safely rule out clinically significant injury. Interobserver variability was substantial. We would not recommend the use of the extension test (+/- point tenderness assessment) as a clinical decision rule to guide radiologic diagnostics in acute elbow trauma.
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Randomized Controlled Trial
Randomized trial of tourniquet vs blood pressure cuff for target vein dilation in ultrasound-guided peripheral intravenous access.
Ten percent of the time, peripheral intravenous access (PIV) is not obtained in 2 attempts in the emergency department. Typically, a tourniquet is used to dilate the target vein; but recent research showed that a blood pressure (BP) cuff improves dilation, which may translate to increased PIV success. ⋯ Tourniquet is superior to BP cuff for target vein dilation in ultrasound-guided PIV.
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We sought to describe epidemiological patterns of acute injuries treated in emergency department (ED) and outpatient primary care settings in the United States. ⋯ Medically attended injuries area common in older adults, and their incidence increases with advancing age. Half of all initial visits for acute injuries in older adults are to primary care clinics. Most injured individuals are discharged home, and injury prevention counseling is rarely documented. To inform injury prevention efforts appropriately and to avoid underestimating the burden of injury, future injury studies should include a range of outpatient and inpatient care settings.
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Central venous catheterization (CVC) is thought to be relatively contraindicated in patients with thrombocytopenia or coagulopathy. We measured the 24-hour incidence of bleeding in septic emergency department (ED) patients undergoing CVC. ⋯ Major bleeding from CVC in ED patients with abnormal hemostasis is rare. Minor bleeding is uncommon and infrequently requires intervention. Successful catheterization on the initial attempt is associated with fewer hemorrhagic complications. These results can inform the risk/benefit calculus for CVC in this population.