Annals of emergency medicine
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Clinical Trial Controlled Clinical Trial
Prochlorperazine induces akathisia in emergency patients.
Prochlorperazine (PCZ), a commonly used antiemetic and analgesic agent, is known to cause akathisia. The incidence of akathisia after a single 10-mg dose of intravenous PCZ has not been prospectively evaluated. We determined the incidence and severity of PCZ-induced akathisia at 1 hour and the incidence of delayed akathisic symptoms at 48 hours. ⋯ Single-dose intravenous PCZ frequently induced akathisia within 1 hour of administration. Acute akathisia was not observed in patients receiving intravenous saline solution or antibiotics. The delayed development of akathisia symptoms 48 hours after a single dose of intravenous PCZ was uncommon.
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We sought to characterize the clinical manifestations, outcome, and etiology of inadvertent ketamine overdose in the emergency department. ⋯ No adverse outcomes were noted in 9 healthy children treated in the ED who inadvertently received 5 to 100 times the intended dose of ketamine. Toxicity manifested as prolonged sedation in all 9 and brief respiratory depression in 4. The margin of safety in ketamine overdose may be wide, although less common and more serious outcomes cannot be excluded by this small, self-reported sample.
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Cardiorespiratory resuscitation (CPR) nonprovision-the failure of bystanders to provide CPR to cardiac arrest victims-remains a well-documented public health problem associated with significant mortality. Multivariate data on failure to provide CPR are limited. Given the established independent contributions of neighborhoods to explaining many behaviors, we asked the following questions: Do neighborhood characteristics affect the likelihood of CPR nonprovision? In particular, we sought to identify the characteristics of areas that have had the most success in providing CPR. ⋯ Substantial variation in rates of CPR nonprovision exists between neighborhoods; the variation is associated with neighborhood characteristics. Combining individual and neighborhood data allows identification of important factors associated with the failure to provide CPR.
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The assessment of patients with poisoning should include assessment of psychiatric details, the level of consciousness, and clinical features occurring in a number of Toxidromes (toxicology syndromes). To ensure these aspects were routinely covered, we introduced a preformatted chart (PFC) to record our poisoning admissions. The aim of our study was to determine whether using a PFC improved the quality, accuracy, and completeness of the data obtained from admissions with poisoning. ⋯ Data collected prospectively with a PFC collects more information than can be obtained retrospectively from case records. In particular, the validity of data on clinical signs on presentation gained from retrospective chart review is questionable. Centers that are interested in collecting data on series of poisonings would benefit from using a PFC or some other systematic prospective method of data collection.
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To conduct an economic analysis of the implementation of the Ottawa Knee Rule. ⋯ Implementation of the Ottawa Knee Rule Would be associated with meaningful reductions in societal health care costs both in the United States and Canada without a reduction in quality of care.