The American journal of emergency medicine
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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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Randomized Controlled Trial Comparative Study Clinical Trial
Ultrasound-assisted paracentesis performed by emergency physicians vs the traditional technique: a prospective, randomized study.
To determine if emergency center ultrasound (ECUS) can be of value to emergency physicians in the evaluation of possible ascites and accompanying decisions to perform emergent paracentesis. ⋯ Ninety-five percent (P=.0003) of the patients who were randomized in the ECUS group and in whom a needle paracentesis was performed had ascitic fluid successfully obtained, as compared with the traditional method group.
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Randomized Controlled Trial Clinical Trial
Nursing use between 2 methods of procedural sedation: midazolam versus propofol.
We compared propofol (P) and midazolam (M) use in sedation using nurses' (RN's) monitoring times, costs, and visual analog scale (VAS) satisfaction scores. We randomized 40 patients to either P or M groups. The P group received 0.5 mg/kg IV followed by titration to a Ramsay Sedation Scale of 3 or 4. ⋯ VAS score differences were significant only in the physician group. We concluded that compared with midazolam, propofol required less RN monitoring and had lower costs. Physician satisfaction was higher with propofol sedation than with midazolam and required less time.
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Randomized Controlled Trial Clinical Trial
Cardiovascular responses in patients with acute allergic reactions treated with parenteral epinephrine.
The present study describes the cardiovascular responses to epinephrine (Epi) given into the arm, in adult patients with acute allergic reactions, and the differential responses to subcutaneous (SC) and intramuscular (IM) administration. Sixty-three adult patients were treated with Epi administered SC or IM after H1 and H2 receptor blockade. Heart rate and blood pressure (BP) were then measured for 20 minutes. ⋯ In conclusion, adults with acute allergic syndromes treated with arm-injected Epi show a modest but definite increase in pulse pressure and systolic BP. This pattern is observed more in males. Heart rate and blood pressure differences between IM and SC arm-injected Epi treatments do not appear to be significant.