Use of ocular ultrasound for the evaluation of retinal detachment.

Background: Retinal detachment is an ocular emergency posing diagnostic difficulty for the emergency practitioner. Direct fundoscopy and visual field testing are difficult to perform and do not completely rule out retinal detachment. Ophthalmologists use ocular ultrasound to enhance their clinical acumen in detecting retinal detachments (RD), and bedside ultrasound capability is readily available to many emergency practitioners (EP).

The utility of routine x-rays in all glass-caused wounds.

It is a common practice to routinely obtain x-rays before clinical evaluation and cleaning of glass-caused wounds to assess for possible retained foreign bodies (FBs). [Am J Surg 1982;144(July):63-5; Ann Emerg Med 1983;12(July):434-7; Emerg Med Clin NorthAm 1985;3(2):383-91; Emerg Med Clin North Am 1992;10:163-77; Ann Emerg Med 1988 17(12):125-34; Emerg Med Clin North Am 1992;10(4):757-79] This prospective study was designed to question whether routine x-rays are necessary for all patients with glass-caused wounds. Plain films were taken before clinical exam but not reviewed until after the exam was completed.

A comparison of phenytoin-loading techniques in the emergency department.

Objectives: To compare the effectivenesses of three phenytoin-loading techniques.

Methods: Patients with subtherapeutic phenytoin concentrations who presented within 48 hours of a seizure were randomized to receive either 20 mg/kg of oral phenytoin (PO), divided in maximum doses of 400 mg every two hours, 18 mg/kg of intravenous phenytoin (IVP) at an initial infusion rate of 50 mg/min, or 18 mg/kg (phenytoin equivalents) of intravenous fosphenytoin (IVF) at an initial infusion rate of 150 mg/min.

Results: A total of 45 patients were enrolled: 16 in the PO group, 14 in the IVP group, and 15 in the IVF group.

Cost-effectiveness of oral phenytoin, intravenous phenytoin, and intravenous fosphenytoin in the emergency department.

Study Objective: Oral phenytoin, intravenous phenytoin, and intravenous fosphenytoin are all commonly used for loading phenytoin in the emergency department (ED). The cost-effectiveness of each was compared for patients presenting with seizures and subtherapeutic phenytoin concentrations.

Methods: A simple decision tree was developed to determine the treatment costs associated with each of 3 loading techniques.

Comparative study of intra-articular lidocaine and intravenous meperidine/diazepam for shoulder dislocations.

The purpose of this study was to compare the analgesic effectiveness of intra-articular lidocaine versus intravenous meperidine and diazepam during the reduction of anterior shoulder dislocations. Patients were randomized to one of the two methods before the reduction of shoulder dislocations. Patients marked a visual analog pain scale at baseline, after anesthesia just before reduction, and at the time of discharge.

Current controversies in shock and resuscitation.

Many controversies and uncertainties surround resuscitation of hemorrhagic shock caused by vascular trauma. Whereas the basic pathophysiology is better understood, much remains to be learned about the many immunologic cascades that lead to problems beyond those of initial fluid resuscitation or operative hemostasis. Fluid therapy is on the verge of significant advances with substitute oxygen carriers, yet surgeons are still beset with questions of how much and what type of initial fluid to provide.

The comparative accuracy of radiolucent foreign body detection using ultrasonography.

The purpose of this prospective study was to determine the accuracy of ultrasonography in detecting radiolucent foreign bodies and to compare the performance of three newly trained emergency physicians with two experienced ultrasound technologists and one radiologist. One hundred-four chicken thighs were penetrated with a needle-driver, half of them embedded with a 1.5 cm toothpick.

Bier block exsanguination: a volumetric comparison and venous pressure study.

Objectives: Intravenous regional anesthesia (IVRA) is a useful ED anesthetic technique. However, venous pressure elevation during injection can cause anesthetic leakage and toxicity. This is minimized by preinjection limb exsanguination.

The effects of simulated Bier block IVRA on intracompartmental tissue pressure.

Background: Intravenous regional anesthesia (IVRA) is a useful anesthetic method for closed reduction of fractures. However, IVRA has been associated with an increased incidence of compartment syndrome when treating tibial shaft fractures. The purpose of this study was to measure changes in anterior leg compartment pressures during simulated IVRA.

Cost analysis of stapling versus suturing for skin closure.

A randomized, prospective study was performed to test the null hypothesis that there is no difference between the cost of stapling and suturing for skin closure of selected linear lacerations. Appropriate wounds were randomly assigned to be closed by staples or sutures. Wound lengths, skin closure times, and the number of staples or the number and types of sutures used were recorded.

Pain comparison of unbuffered versus buffered lidocaine in local wound infiltration.

The purpose of this study was to compare the pain of infiltration between unbuffered lidocaine and buffered lidocaine in a traumatic laceration. Solutions of unbuffered 1% lidocaine and buffered 1% lidocaine were randomly assigned to Site I or Site II of a single laceration for each subject, with the patient serving as self-control. Pain scores were recorded for each site, and an anesthetic preference was determined for each patient.

The validity and reliability of the navicular fat stripe as a screening test for detection of navicular fractures.

Study Objective: The purpose of this study was to determine if the navicular fat stripe (NFS) is a valid and reliable screening tool in assessing potential navicular fractures.

Design: Retrospective analysis.

Setting: Minor trauma section of the Los Angeles County-University of Southern California Medical Center emergency department.