The American journal of emergency medicine
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Letter Case Reports
Injection of pyrethroids without significant sequelae.
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Review Meta Analysis
The prehospital 12-lead electrocardiogram's effect on time to initiation of reperfusion therapy: a systematic review and meta-analysis of existing literature.
The prehospital electrocardiogram (ECG) is becoming the standard of care of suspected cardiac chest pain. We evaluated the evidence regarding the prehospital ECG and sought to quantify the reduction in time to reperfusion therapy attributable to the prehospital ECG. We conducted a systematic review and analyzed studies that were conducted in emergency medical systems relevant to providers in the United States. ⋯ A meta-analysis of these studies revealed a difference of 24.7 (95% confidence interval, 16.7-32.7) minutes. Providers now have a quantified value of the prehospital ECG based on the best published evidence. In addition, this search showed a relatively low quality and quantity of research on the prehospital ECG.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Nesiritide added to standard care favorably reduces systolic blood pressure compared with standard care alone in patients with acute decompensated heart failure.
The Prospective Randomized Outcomes study of Acutely decompensated Congestive heart failure Treated Initially as Outpatients with Nesiritide (PROACTION) trial evaluated the safety of nesiritide administration in the emergency department in patients with decompensated heart failure. Patients (N=237) were treated for at least 12 hours with standard care plus either intravenous nesiritide or placebo. ⋯ Both treatment groups had similar incidences of symptomatic and asymptomatic hypotension. These data demonstrate that early administration of nesiritide in the emergency department is a safe and effective treatment of heart failure.
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Randomized Controlled Trial Clinical Trial
Etomidate and midazolam for procedural sedation: prospective, randomized trial.
To evaluate whether there is a difference in the time of sedation and time to patient disposition in patients undergoing procedural sedation with etomidate and midazolam. ⋯ The use of etomidate compared with midazolam for procedural sedation provides a significant reduction in recovery time, without a reduction in time to patient disposition, while providing equal sedation quality.
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Review Case Reports
Orthopedic pitfalls in the ED: tibial plafond fractures.
Fractures of the tibial plafond, or distal tibial articular surface, are usually associated with a high-force mechanism, which frequently can involve associated injuries and prolonged disability. Because of distracting injury and variations in clinical findings, tibial plafond fractures may be initially missed or misdiagnosed. This review examines the clinical presentation, diagnostic techniques, and management of tibial plafond fractures applicable to the emergency practitioner.