Annals of emergency medicine
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B-type natriuretic peptide (BNP) is an established tool for the diagnosis of acute congestive heart failure in patients presenting with dyspnea. Some patients have moderately elevated BNP levels (ie, 100 to 500 pg/mL) in the absence of acute congestive heart failure. The objective of the current study was to identify independent predictors of elevated BNP concentrations in the absence of congestive heart failure. ⋯ Knowledge of these commonly obtained variables should aid clinicians in the interpretation of moderately elevated BNP results in patients presenting with acute dyspnea in the emergency department.
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Randomized Controlled Trial Multicenter Study Clinical Trial
The Australasian Clinical Toxicology Investigators Collaboration randomized trial of different loading infusion rates of N-acetylcysteine.
We determine whether the incidence of adverse events caused by intravenous N -acetylcysteine is significantly less when the initial dose is infused over a 60-minute period compared with the standard infusion period of 15 minutes. A secondary objective is to assess the efficacy of the 2 treatment arms. ⋯ This study did not demonstrate a reduction of drug-related adverse outcomes with the 60-minute infusion. The study also confirmed that early treatment with N -acetylcysteine (within 8 hours of ingestion) is more effective than later treatment.
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Multicenter Study
Emergency department visits for outpatient adverse drug events: demonstration for a national surveillance system.
This project demonstrates the operational feasibility and epidemiologic usefulness of modifying a national injury surveillance system for active surveillance of outpatient adverse drug events treated in hospital emergency departments (EDs). ⋯ Active surveillance for outpatient adverse drug events using the National Electronic Injury Surveillance System-All Injury Program is feasible. Ongoing, population-based ED surveillance can help characterize the burden of outpatient adverse drug events, prioritize areas for further research and intervention, and monitor progress on adverse drug event prevention.
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We determine the interval between stroke symptom onset and time to emergency department (ED) arrival and factors associated with delays in presentation. ⋯ There are considerable delays between stroke symptom onset and ED arrival. Programs to improve awareness of patients with stroke to seek medical help immediately may reduce unnecessary delays to ED arrival.
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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.