Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Pain of local anesthetics: rate of administration and buffering.
To determine the impact of administration rate and buffering on the pain associated with subcutaneous infiltration of lidocaine. ⋯ This is the largest blinded study to assess administration rate and the pain of a local anesthetic. We found that administration rate had a greater impact on the perceived pain of lidocaine infiltration than did buffering.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage.
To compare the efficacy of the Valsalva maneuver with that of carotid sinus massage (CSM) in terminating paroxysmal supraventricular tachycardia (SVT) in the ED. ⋯ Vagal maneuvers are efficacious in terminating about one quarter of spontaneous SVT cases. There is no detectable difference in efficacy between the Valsalva maneuver and CSM.
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To compare the efficacy of the Valsalva maneuver with that of carotid sinus massage (CSM) in terminating paroxysmal supraventricular tachycardia (SVT) in the ED. ⋯ Vagal maneuvers are efficacious in terminating about one quarter of spontaneous SVT cases. There is no detectable difference in efficacy between the Valsalva maneuver and CSM. [Lim SH, Anantharaman V, Teo WS, Goh PP, Tan ATH: Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage. Ann Emerg Med January 1998;31:30-35.].
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Comparative Study
Use of troponin T and creatine kinase-MB subunit levels for risk stratification of emergency department patients with possible myocardial ischemia.
To evaluate and compare the utility of measurement of troponin T and the creatine kinase MB subunit (CK-MB) for risk stratification of ED patients with possible myocardial ischemia. ⋯ A positive test result for either troponin T or CK-MB in the ED successfully identified patients at significantly higher risk of adverse events during the 2 weeks following their ED visit. The two markers may complement each other in that each appears to have prognostic ability among a unique patient subgroup. ED marker measurement can provide useful prognostic information for patients with a broad spectrum of presentations consistent with possible myocardial ischemia.
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Case Reports
Bolus thrombolytic infusions during CPR for patients with refractory arrest rhythms: outcome of a case series.
Thrombolytic therapy has been accepted in the treatment of acute myocardial infarction. Given historical recommendations that thrombolytic therapy is contraindicated in patients receiving CPR, its potential clinical benefit for facilitating conversion of rhythm in patients in refractory cardiac arrest has not been investigated. We present three case reports in which patients with confirmed acute myocardial infarction had a witnessed cardiac arrest in the ED. ⋯ Patients were given tissue plasminogen activator and had defibrillation, followed by a spontaneous return of circulation, with resuscitation and subsequent discharge. No postarrest sequelae were observed as a result of thrombolytic use during the resuscitative process. We conclude that bolus thrombolytic infusions during CPR may facilitate spontaneous return of circulation in select patients with confirmed acute myocardial infarction, witnessed cardiac arrest in the ED, and refractory ventricular fibrillation or tachycardia.