The American journal of emergency medicine
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Comparative Study
Can nurses appropriately interpret the Ottawa Ankle Rule?
The objective of this study was to determine if ED triage nurses could appropriately interpret the Ottawa Ankle Rules (OAR). We conducted a prospective, observational trial of a clinical decision rule in a suburban ED on a convenience sample of ED patients, aged >17 years with acute ankle injuries. Nurses and EPs were trained in the appropriate use of the OAR. ⋯ Sensitivity of the EP's utilization of the OAR for fracture was 92%, specificity 47% with a negative predictive value 94%, and a positive predictive value 38%. Nurses showed only a moderate ability to interpret the overall OAR for ordering of x-rays. Nurses' understanding of the individual criterion were variable.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Efficacy of accelerated dose titration of olanzapine with adjunctive lorazepam to treat acute agitation in schizophrenia.
We conducted a prospective double-blind study of accelerated dose titration of olanzapine in the treatment of newly admitted acutely agitated patients with schizophrenia. Patients were randomized to either oral olanzapine (10 mg per day) or oral haloperidol (10 mg per day), plus lorazepam as needed (up to 12 mg per day). ⋯ Significant within-group improvement was demonstrated in PANSS Agitation scores for both groups as early as 1 hour after initiating therapy (-5.79 +/- 6.30 for olanzapine and -4.89 +/- 6.05 for haloperidol, P <.001). This study demonstrated that accelerated dose titration of oral olanzapine is as efficacious as oral haloperidol in reducing acute agitation in patients with schizophrenia.
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QTc dispersion in the electrocardiogram (ECG) is a new important prognostic factor for many diseases, but its role in intracerebral hemorrhage (ICH) is not clear. This study was performed to investigate the prognostic significance of QTc dispersion in the acute ICH patients. We studied the differences of QTc dispersion from the initial ECG in the ED between the survival to discharge and nonsurvival patients retrospectively. ⋯ The QTc dispersion and GCS were the statistically significant independent predictors in the multiple logistic analyses. Increased QTc dispersion in the initial ED electrocardiograph is an important prognostic factor for ICH patients. More attention to the disposition and intensive care should be given for these patients.
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Although it is generally believed that unintentional ingestions of fluoxetine by children are relatively safe, there are no large published studies supporting this concept. The goal of this retrospective study is to determine the signs and symptoms of these children. Inclusion criteria included fluoxetine exposures from six certified regional poison centers: <6 years old, known amount, single substance, 20 mg or more ingested, and follow up done to determine outcome. ⋯ In 48 cases, a milligram per kilogram dose was calculated, and the median dose ingested was 2.26 mg/kg. In 92% of the cases, the amount ingested was 60 mg or below. These children will have no adverse effects or only minimal effects and require no emergency treatment or gastric decontamination.