The American journal of emergency medicine
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Randomized Controlled Trial Clinical Trial
Efficacy of superactivated charcoal administered late (3 hours) after acetaminophen overdose.
The purpose of this study was to investigate the effect of superactivated charcoal (SAC) given late after a drug overdose. Acetaminophen was chosen as our overdose drug because it has relatively few side effects, serum levels are easily attainable and measurable, and it is generally a common drug overdose. Forty-six healthy adult volunteers participated in this randomized, controlled study. ⋯ Serum acetaminophen levels were measured at 4 and 7 hours after the initial acetaminophen administration. There were significantly lower uncorrected and corrected acetaminophen levels in the SAC group compared with the control group at both 4 and 7 hours after ingesting acetaminophen. This randomized human experimental design trial demonstrates some detoxification benefit in administering superactivated charcoal 3 hours after an overdose.
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Randomized Controlled Trial Comparative Study Clinical Trial
Calming versus sedative effects of intramuscular olanzapine in agitated patients.
Distinct calming rather than nonspecific sedation is desirable for the treatment of acute agitation. In 3 double-blind studies, acutely agitated patients with schizophrenia (N = 311), bipolar mania (N = 201), or dementia (N = 206) were treated with intramuscular (1-3 injections/24 hrs) olanzapine (2.5-10.0 mg), haloperidol (7.5 mg), lorazepam (2.0 mg), or placebo. The Agitation-Calmness Evaluation Scale (ACES; Eli Lilly and Co.) and treatment-emergent adverse events assessed sedation. ⋯ Excluding asleep patients, agitation remained significantly more reduced with olanzapine than placebo (P <.05). The incidences of adverse events indicative of sedation were not significantly different with olanzapine versus comparators. For the treatment of acute agitation associated with schizophrenia, bipolar mania, or dementia, intramuscular olanzapine-treated patients experienced no more sedation than haloperidol- or lorazepam-treated patients and experienced distinct calming rather than nonspecific sedation.
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Randomized Controlled Trial Clinical Trial
Bedside ultrasound to determine prandial status.
The prandial status of ED patients is often unknown. Because a full stomach predisposes patients to aspiration during a variety of urgent interventions, a method of determining the degree of gastric fullness would be of potential clinical importance. The purpose of this single-blind interventional trial was to determine if bedside ultrasound, performed by EPs, could accurately determine prandial status. ⋯ We found that the technique was specific in identifying a full stomach but only moderately reliable in identifying an empty one. Best results (sensitivity S + 86%, specificity S- 70%, accuracy A+ 78%) were achieved only after water ingestion with the patient in the RLD position. We conclude that bedside ultrasound is of only limited value for determining prandial states in the ED setting.
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Randomized Controlled Trial Comparative Study Clinical Trial
Minimum clinically significant VAS differences for simultaneous (paired) interval serial pain assessments.
We conducted two studies to determine whether the minimum clinically significant difference in the visual analog scale (VAS) for nearly simultaneous and brief-interval serial assessments of pain is less than that for pain assessment at 20- to 30-minute intervals, using a 10-cm VAS. The first study was a blinded, randomized, placebo-controlled paired trial comparing the pain of intravenous cannulation in both hands (20-minute application of a eutectic mixture of local anesthetics v placebo) of study subjects. The second study was a non-blinded, randomized, paired trial of different treatments for jellyfish stings. ⋯ On the basis of these findings, the minimum clinically significant VAS difference for paired comparisons that are simultaneous or occur within 5 minutes of each other is about 0.5 cm or less. This value is less than the 1.3-cm value determined for serial 20- to 30-minute pain comparisons. It is likely that other types of pain comparisons may have different minimum clinically significant VAS differences.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective double-blind study of nasal sumatriptan versus IV ketorolac in migraine.
We conducted a study to compare the efficacy in migraine headache of nasal sumatriptan and intravenous ketorolac. The study was a prospective, double-blind study done with a convenience sample of 29 patients presenting to the emergency department (ED) with acute migraine. Patients received either 20 mg of nasal sumatriptan or 30 mg of intravenous ketorolac. ⋯ One hour after medication, the sumatriptan group had a decrease in pain score of 22.937 mm and the ketorolac group a decrease of 71.462 mm on the VAS. The decrease in pain score with ketorolac was significantly greater than that with sumatriptan (P < 0.001). The study therefore showed that both sumatriptan and ketorolac effectively reduced the pain associated with acute migraine headache, but that intravenous ketorolac produced a greater reduction in pain than did nasal sumatriptan.