The American journal of emergency medicine
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Randomized Controlled Trial Clinical Trial
Does morphine change the physical examination in patients with acute appendicitis?
The objective of this study was to determine if judicious dosing of morphine sulfate can provide pain relief without changing important physical examination findings in patients with acute appendicitis. We conducted a prospective, randomized, double-blind crossover design. Patients scheduled for appendectomy were randomized to two groups. ⋯ Three patients in both groups were judged to have a change in their examination after medication. The median change in VAS was 20 mm after morphine and 0 mm after placebo (P =.01). In this pilot study, patients with clinical signs of appendicitis were treated with morphine and had significant improvement of their pain without changes in their physical examination.
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The study objective was to determine the accuracy of initial triage assessment (ITA) in directing behavioral emergency patients to appropriate medical or psychiatric care, and to identify variables that enhance triage accuracy. A cohort study of 436 adult patients with 1 of 10 behavioral-related complaints was conducted. ITA compared with the final ED diagnosis, both of which were classified as either "medical" or "psychiatric." Patient triage characteristics correlated with the final ED diagnosis using logistic regression. ⋯ Dementia, past psychiatric history, family history of psychiatric illness, and ITA were significant predictors of final ED diagnosis. ITA is a fair predictor of the final ED diagnosis, but could be enhanced by screening for dementia and past psychiatric history. Improved triage accuracy could reduce length of stay for such patients.
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Comparative Study
Gas flow rates through transtracheal ventilation catheters.
The purpose of the study was to measure gas flow rates using different methods of transtracheal ventilation. Wall oxygen flow (WOF) at 10 and 15L/min, and a self-inflating ventilation bag (SIVB) were used to deliver gas flow through three transtracheal catheters: 13, 14, and 16 gauge (5 trials each). WOF mean gas flow rates (L/min) through the 16G, 14G, 13G catheters, respectively were: 15.7, 15.7, 16.8 at 15L/min, 10.5, 10.5, 10.3 at 10 L/min, and 5.7, 7.5, 7.7 via SIVB. ⋯ A 500 cc tidal volume can be delivered within 3 seconds (WOF) and 5 seconds (SIVB). Catheter size did not substantially affect gas flow rates (Poiseuille's law not applicable). Transtracheal ventilation is best done by using WOF, but if a device to perform this is not available, then an SIVB may still be sufficient.
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There has been a marked increase in the use of unpowered scooters over the past few years. Along with this, there has been an increase in injuries related to their use. The objective of this study was to review the unpowered scooter-related injury reports compiled by the United States Consumer Product Safety Commission (CPSC) and to describe the scope and type of injuries sustained. ⋯ Although most injuries were relatively minor, there were 15 deaths reported. Although most injuries occurred in older children and young adolescents, the very young and adults were not immune from injuries. The risk of injury from unpowered scooters and the need for safety awareness should be stressed to all individuals including the very young and adults.