Annals of emergency medicine
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Asthmatic patients have marked circadian variation in disease severity, with bronchospasm far worse between midnight and 8 AM than at other times of day. In this study we sought to determine whether circadian variation in asthma severity is clinically relevant for purposes of emergency management. ⋯ In our study group, asthmatic patients who presented nocturnally to the ED did not differ from other asthmatic patients in disease severity and therefore do not appear to represent a unique population for purposes of ED management or disposition decisions.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized, placebo-controlled evaluation of prochlorperazine versus metoclopramide for emergency department treatment of migraine headache.
To determine the comparative efficacy of i.v. metoclopramide and prochlorperazine for the initial emergency department treatment of migraine headache. ⋯ i.v. prochlorperazine relieves the headache and tends to improve nausea better than metoclopramide in ED patients with acute migraine headache.
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To examine the spectrum of electrical injuries and develop guidelines for management. ⋯ Children involved in electrical events are usually exposed to low-voltage household current resulting in minor injury. Asymptomatic children with minor electrical injuries do not require laboratory evaluation or hospitalization.
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Randomized Controlled Trial Clinical Trial
Treatment of acute bronchospasm with beta-adrenergic agonist aerosols delivered by a nasal bilevel positive airway pressure circuit.
To determine whether beta-adrenergic agonist aerosols are more effective in treating acute bronchospasm if delivered by nasal bilevel positive airway pressure (BiPAP) than by a small-volume nebulizer (SVN). We hypothesized that BiPAP would reduce the work of breathing in asthmatic patients and thereby hasten improvement of bronchospasm from beta-agonist therapy. Previous trials with aerosols given by intermittent positive-pressure breathing were unrewarding, but BiPAP is unique in that inspiratory (IPAP) and expiratory (EPAP) support pressures may be set separately. ⋯ In this population, response to initial ED management of bronchospasm, as measured by PEFR, was better with aerosols delivered by BiPAP than with those delivered by SVN.