Biomedical subjects
Publications and source records attributed to J W Runge.
The public health problem of injury has an enormous impact on individuals and society, both as a health and economic issue. Prior to the last decade, little attention has been paid to the costs generated by injury, much of which is preventable. By looking at aggregate economic costs for different injuries and population groups, the physician can understand where the problems occur that need to be addressed to curb this staggering burden on society.
STUDY OBJECTIVE: We compared the efficacies of cimetidine (an H2-receptor antagonist) and diphenhydramine (an H1-receptor antagonist) alone and in combination for alleviation of symptoms of acute allergic reactions. STUDY DESIGN AND INTERVENTIONS: In this prospective, randomized, double-blind study, patients and examiners assessed the severity of symptoms and signs of acute allergic reactions using a visual-analog scale before treatment and 30 minutes after treatment with 300 mg IV cimetidine and placebo, 50 mg IV diphenhydramine and placebo, or diphenhydramine plus cimetidine. SETTING AND PARTICIPANTS: Thirty-nine patients with acute allergic reactions presenting to two emergency departments of teaching hospitals. RESULTS: Of the 35 patients with pruritus, all 12 receiving diphenhydramine placebo had clinically significant relief compared with six of ten (60%) receiving cimetidine plus placebo (P = .03). Twelve of 13 (92%) receiving diphenhydramine plus cimetidine had relief, which was not a significant difference from the single drugs. Comparison of mean differences in pretreatment and post-treatment symptom scores (relief scores) among groups of patients with pruritus detected significantly more relief in the group receiving diphenhydramine plus placebo (80.3 +/- 7.4) than in those receiving cimetidine plus placebo (48.8 +/- 13.4) (P = .022). Of the 33 patients with urticaria, five of 11 (46%) receiving diphenhydramine plus placebo had clinically significant relief compared with eight of ten (80%) receiving cimetidine plus placebo (P = .18). Eleven of 12 patients (92%) receiving diphenhydramine plus cimetidine had relief, which is a significant difference from those receiving diphenhydramine plus placebo (P = .027). Comparison of mean relief scores in patients with urticaria detected significantly more relief in the group receiving diphenhydramine plus cimetidine (55.3 +/- 6.5) than in the group receiving diphenhydramine plus placebo (30.7 +/- 6.1) (P = .006). CONCLUSION: For treatment of pruritus from acute allergic reactions, diphenhydramine is more effective than cimetidine, and the combination offers no additional benefit. For treatment of acute urticaria, the combination of cimetidine and diphenhydramine is more effective than diphenhydramine alone.
STUDY PURPOSE: Little information exists on the cause of injury for patients who are treated and discharged from emergency departments; these patients comprise approximately 90% of all injured patients requiring medical care. A method is described to assign external cause of injury codes (E codes) prospectively to all injured patients seen in a large-volume ED. METHODS: E code assignment was performed by the ED triage nurses on entrance to the ED. A checklist was used that contained frequently occurring codes as identified in a pilot study. E codes were entered into the patients' records on the hospital mainframe computer by a medical records technician. These were acquired for a nine-month period to determine feasibility, accuracy, and ease of use. Accuracy was verified retrospectively. RESULTS: During the nine-month period, 67,495 patients were treated. Acute injury accounted for 16,186 of the visits, and 2,085 were return visits for a previously treated injury. The majority of patients with any injury type were treated and discharged and would not have been included in traditional data sets of injured patients. Overall admission rate for injury was 13%. Accuracy of prospectively assigned E codes was 98%, and this method of assigning E codes resulted in no additional effort by the triage nurse. CONCLUSION: E coding is a valuable method for injury surveillance, easily performed in EDs with high volume. Its value is essential for injury prevention research on injuries from any cause.
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Pain from ureteral stones is believed to be due to spasm and hyper-peristalsis of the involved ureter. Nifedipine has been shown to decrease human ureteral spasm in vitro. Conflicting results have been reported concerning the clinical efficacy of nifedipine in relieving acute renal colic. This prospective, double-blind, crossover clinical trial evaluated the acute pain relief obtained in 30 patients who had ureteral stones. All patients had ureteral stones documented either by plain abdominal radiograph (six), intravenous pyelogram (16), or passage of the stone(s) in the urine (eight). Each patient served as his own control. The mean pain relief scores for placebo versus 10 to 20 mg oral nifedipine were 0.7 +/- 1.8 and 1.2 +/- 2.5, respectively, as measured on a visual analogue scale (P = .404). Seven patients received clinically significant relief associated with nifedipine, and three patients received relief from placebo (P = .300). Twenty patients (66%) did not experience clinically significant relief from either treatment. We conclude that nifedipine does not differ significantly from placebo in providing relief from acute renal colic.
This article is intended as an overview of emergencies that could and often do present to the physician's office, especially when a hospital emergency department may not be nearby. It is not intended as an in-depth view of every problem but should be considered as a presentation of essential management in the emergency phase of treatment. The reader is directed to the references for more in-depth information on these topics.
Pharyngitis is an illness frequently treated by emergency physicians and primary care practitioners. It is the subject of much controversy regarding optimal treatment in the acute care setting. This review discusses pertinent aspects of the pathophysiology, clinical features, diagnosis, and treatment based on available literature. This review is also meant to serve as a bibliographic resource for some of the controversies of this complex topic.
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