Annals of emergency medicine
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Randomized Controlled Trial Multicenter Study
A randomized controlled trial of prochlorperazine versus metoclopramide for treatment of acute migraine.
We compare prochlorperazine 10 mg intravenously versus metoclopramide 20 mg intravenously for the emergency department (ED) treatment of acute migraine. ⋯ Either prochlorperazine 10 mg intravenously or metoclopramide 20 mg intravenously, combined with diphenhydramine 25 mg intravenously, is an efficacious treatment for ED patients with acute migraine. Three quarters of subjects in both arms would want the same medication for their next migraine.
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Numerous investigators have evaluated the ECG algorithm described by Sgarbossa et al to predict acute myocardial infarction in the presence of left bundle branch block and have arrived at divergent conclusions. To clarify the utility of the Sgarbossa ECG algorithm, we perform a systematic review and meta-analysis of these trials. ⋯ A Sgarbossa ECG algorithm score of greater than or equal to 3, representing greater than or equal to 1 mm of concordant ST elevation or greater than or equal to 1 mm ST depression in leads V1 to V3, is useful for diagnosing acute myocardial infarction in patients who present with left bundle branch block on ECG. The scoring system demonstrates good to excellent overall interobserver variability. A score of 2, representing 5 mm or more of discordant ST deviation, demonstrated ineffective positive likelihood ratios. A Sgarbossa ECG algorithm score of 0 is not useful in excluding acute myocardial infarction.
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Recent studies have proposed the use of D-dimer as a screening tool to "rule out" acute aortic dissection, claiming a sensitivity approaching 100%. We reviewed the literature to determine whether D-dimer can be used as the sole screening tool for acute aortic dissection. An Ovid MEDLINE search, 1966 to present, was performed with the key words "aortic dissection," "fibrin degradation products," and "D-dimer," limited to "human" and "English language." Ten original research articles were identified that directly addressed the use of D-dimer in acute aortic dissection. ⋯ However, 38% of dissections are missed on initial evaluation, and there are no validated clinical decision rules for the clinical diagnosis of acute aortic dissection. Clinical suspicion and chest radiograph findings were the only tools for determining which patients require further imaging until recent studies proposed the use of D-dimer as a screening tool for acute aortic dissection, claiming a sensitivity approaching 100%. Our goal was to evaluate the current literature for the use of D-dimer as the sole screening tool for acute aortic dissection.
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Propofol is rapidly becoming one of the most popular procedural sedation and analgesia agents in emergency medicine. However, in many hospitals emergency physicians lack access to this potent sedative. This article details the evidence and politics underlying this area of controversy, the nature and authority of hospital-wide sedation policies, and discussion of the most common criticisms of emergency department use of propofol.
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Randomized Controlled Trial
A prospective, randomized trial of an emergency department observation unit for acute onset atrial fibrillation.
An emergency department (ED) observation unit protocol for the management of acute onset atrial fibrillation is compared with routine hospital admission and management. ⋯ An ED observation unit protocol that includes electrical cardioversion is a feasible alternative to routine hospital admission for acute onset of atrial fibrillation and results in a shorter initial length of stay.