Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
End-tidal carbon dioxide during out-of-hospital cardiac arrest resuscitation: comparison of active compression-decompression and standard CPR.
To compare the maximal end-tidal carbon dioxide pressure (ETCO2 peak) values obtained during standard (S-CPR) and active compression-decompression CPR (ACD-CPR) during prolonged resuscitation in out-of-hospital cardiac arrest. ⋯ This prospective study suggests that ACD-CPR may improve cardiac output compared with S-CPR.
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To assess patients' comprehension of their emergency department discharge instructions and to determine if inner-city patients' literacy levels are adequate to comprehend written discharge instructions. ⋯ Overall comprehension rates in this population were good despite the fact that ED instruction sheets were written at an inappropriately high reading level. Verbal instructions given by the discharging physician likely have a significant effect on patients' comprehension of instructions.
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Comparative Study
Reliability of infrared tympanic thermometry in the detection of rectal fever in children.
Recently published clinical guidelines for the management of febrile children are based on studies that used rectal temperature data to stratify the risk of bacteremia and septic complications. Appropriate management decisions rely on accurate detection and categorization of fever. Accordingly, this study compared the newer infrared tympanic thermometry (ITT) to rectal thermometry in this regard. ⋯ Despite the statistical correlation between ITT and rectal temperatures, the modalities may yield significantly different temperatures. The poor sensitivity of ITT in detecting fever and high fever may result in clinically important miscategorizations of individual patients. Current clinical management that is based on the presence and height of fever may be adversely affected if ITT is used.
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To assess the effectiveness of a specific, targeted clinical policy regarding the evaluation of nontraumatic chest pain in the emergency department (ED) to modify physician evaluation and management. ⋯ We conclude that the dissemination of the ACEP chest pain clinical policy has not significantly modified the behavior of our metropolitan area emergency physicians regarding the evaluation and management of patients who present to the ED with a chief complaint of nontraumatic chest pain.