Annals of emergency medicine
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Comparative Study
Comparison of consciousness level assessment in the poisoned patient using the alert/verbal/painful/unresponsive scale and the Glasgow Coma Scale.
We determine how the alert/verbal/painful/unresponsive (AVPU) responsiveness scale (alert, responsive to verbal stimulation, responsive to painful stimulation, and unresponsive) corresponds to the Glasgow Coma Scale (GCS) when assessing consciousness level in the poisoned patient. ⋯ Each AVPU category can be shown to correspond to a range of GCS scores. The AVPU responsiveness scale appears to provide a rapid simple method of assessing consciousness level in most poisoned patients, but difficulty was still observed in assessing alcohol-intoxicated patients.
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Comparative Study Clinical Trial
Ultrasonography of the internal jugular vein in patients with dyspnea without jugular venous distention on physical examination.
Accurate physical examination of patients with dyspnea is important. Jugular venous distention, however, can be difficult to assess in patients. The purpose of this case series is to serve as a pilot study of how ultrasonographic examination of the internal jugular vein compares with other measures of dyspnea. ⋯ Ultrasonographic examination of the internal jugular vein appears to be helpful in patients who present with dyspnea but do not have evidence of jugular venous distention on physical examination.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Nebulized lidocaine decreases the discomfort of nasogastric tube insertion: a randomized, double-blind trial.
Nasogastric tube insertion is a common emergency department (ED) procedure that is associated with considerable patient discomfort. The safety and efficacy of nebulized lidocaine for upper airway anesthesia have previously been demonstrated. We determine whether nebulized lidocaine administered before nasogastric tube insertion significantly reduces patient discomfort. ⋯ Nebulized lidocaine decreases the discomfort of nasogastric tube insertion and should be considered before passing a nasogastric tube. An increased frequency of epistaxis, however, may be associated with its use.
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We determine the relative risk and severity of traumatic brain injury among occupants of lateral impacts compared with occupants of nonlateral impacts. ⋯ Lateral impact is an important independent risk factor for the development of traumatic brain injury after a serious motor vehicle crash. Traumatic brain injuries incurred after lateral impact are more severe than those resulting from nonlateral impact. Vehicle modifications that increase head protection could reduce crash-related severe traumatic brain injuries by up to 61% and prevent up to 2,230 fatal or critical traumatic brain injuries each year in the United States.