Annals of emergency medicine
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Randomized Controlled Trial Multicenter Study
A Randomized, Double-Blind, Placebo-Controlled Trial of Naproxen With or Without Orphenadrine or Methocarbamol for Acute Low Back Pain.
In US emergency departments (EDs), patients with low back pain are often treated with nonsteroidal anti-inflammatory drugs and muscle relaxants. We compare functional outcomes among patients randomized to a 1-week course of naproxen+placebo versus naproxen+orphenadrine or naproxen+methocarbamol. ⋯ Among ED patients with acute, nontraumatic, nonradicular low back pain, combining naproxen with either orphenadrine or methocarbamol did not improve functional outcomes compared with naproxen+placebo.
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Randomized Controlled Trial Multicenter Study
Preoxygenation With Flush Rate Oxygen: Comparing the Nonrebreather Mask With the Bag-Valve Mask.
Nonrebreather masks and bag-valve masks are used for preoxygenation before emergency intubation. Flush rate oxygen delivered with a nonrebreather mask is noninferior to bag-valve mask oxygen at 15 L/min. We seek to compare the nonrebreather mask with flush rate oxygen to a bag-valve mask with flush rate oxygen (with and without inspiratory assistance) and determine whether the efficacy of bag-valve mask with flush rate oxygen is compromised by a simulated mask leak. ⋯ With flush rate oxygen, the nonrebreather mask is noninferior to the bag-valve mask, with and without inspiratory assistance. Bag-valve mask performed poorly with a mask leak, even with flush rate oxygen. Flush rate oxygen with a nonrebreather mask is a reasonable default preoxygenation method in spontaneously breathing patients with no underlying respiratory pathology.
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Multicenter Study
Opioid Prescribing for Opioid-Naive Patients in Emergency Departments and Other Settings: Characteristics of Prescriptions and Association With Long-Term Use.
We explore the emergency department (ED) contribution to prescription opioid use for opioid-naive patients by comparing the guideline concordance of ED prescriptions with those attributed to other settings and the risk of patients' continuing long-term opioid use. ⋯ Compared with non-ED settings, opioid prescriptions provided to opioid-naive patients in the ED were more likely to align with CDC recommendations. They were shorter, written for lower daily doses, and less likely to be for long-acting formulations. Prescriptions from the ED are associated with a lower risk of progression to long-term use.
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Randomized Controlled Trial Multicenter Study
Acetaminophen or Nonsteroidal Anti-Inflammatory Drugs in Acute Musculoskeletal Trauma: A Multicenter, Double-Blind, Randomized, Clinical Trial.
We determine whether pain treatment with acetaminophen was not inferior to nonsteroidal anti-inflammatory drugs or the combination of both in minor musculoskeletal trauma. ⋯ Pain treatment with acetaminophen was not inferior to that with diclofenac or the combination of acetaminophen and diclofenac in acute minor musculoskeletal extremity trauma, both in rest and with movement.
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Multicenter Study
Effect of Automated Prescription Drug Monitoring Program Queries on Emergency Department Opioid Prescribing.
We assess whether an automated prescription drug monitoring program intervention in emergency department (ED) settings is associated with reductions in opioid prescribing and quantities. ⋯ An automated prescription drug monitoring program query intervention was not associated with reductions in ED opioid prescribing or quantities, even in patients with previous high-risk opioid use.