Annals of emergency medicine
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Forced air speeds rewarming in accidental hypothermia.
To compare the rates of rewarming of forced-air and passive insulation as a treatment for accidental hypothermia. ⋯ Forced air accelerated the rate of rewarming without producing apparent complications in hypothermic patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of bupivacaine and lidocaine/bupivacaine for local anesthesia/digital nerve block.
We compared the efficacy, degree of discomfort, and time elapsed before anesthesia of digital block with a combination of 1% lidocaine/.25% bupivacaine and with .25% bupivacaine alone. ⋯ Bupivacaine .25% digital block induces anesthesia in the same period of time and with equivalent pain of injection as a 1:1 lidocaine 1%/bupivacaine .25% combination. It is not necessary to use lidocaine/bupivacaine in an attempt to achieve faster onset of local anesthesia.
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To determine the amount of change in pain severity, as measured by a visual analog scale, that constitutes a minimum clinically significant difference. ⋯ The minimum clinically significant change in patient pain severity measured with a 100-mm visual analog scale was 13 mm. Studies of pain experience that report less than a 13-mm change in pain severity, although statistically significant, may have no clinical importance.
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Little is known about the accuracy and reliability of current triage methods. We examined agreement among observers with regard to the need for ED care and the ability to predict at triage the need for admission to the hospital and compared these findings with admission rates after medical evaluation and management. ⋯ We found great variability among physicians, nurses, and a computer program with regard to triage decisions. Comparison of the three groups' triage decisions with actual data after medical evaluation and management showed that none of the three performed well in predicting which patients required admission. Until triage methods are standardized and validated, triage decisions should not be used to determine the timeliness of access to emergency care.