The American journal of emergency medicine
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Randomized Controlled Trial Multicenter Study Comparative Study
A randomized controlled trial of intranasal fentanyl vs intravenous morphine for analgesia in the prehospital setting.
The objective of the study was to compare intranasal fentanyl (INF) with intravenous morphine (IVM) for prehospital analgesia. ⋯ There was no significant difference in the effectiveness of INF and IVM for prehospital analgesia.
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The objective of the study was to determine the sensitivity and specificity of abnormal ascitic fluid appearance in the detection of spontaneous bacterial peritonitis (SBP), as a sensitivity approaching 100% could exclude SBP if the fluid is clear. ⋯ Abnormal fluid appearance has a high sensitivity for the detection of SBP. Thus, clear fluid might safely exclude SBP.
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Randomized Controlled Trial
Prehospital analgesia with acupressure at the Baihui and Hegu points in patients with radial fractures: a prospective, randomized, double-blind trial.
Pain during transportation is a common phenomenon in emergency medicine. As acupressure has been deemed effective for pain management by the National Institutes of Health, we conducted a study to evaluate its effectiveness in prehospital patients with isolated distal radial fracture. ⋯ Acupressure in the prehospital setting effectively reduces pain and anxiety in patients with distal radial trauma.
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Bedside transthoracic echocardiography (TTE) performed by emergency physicians (EPs) is valuable in the rapid assessment and treatment of critically ill patients. We sought to determine the preferred cardiac window for left ventricular ejection fraction (LVEF) estimation by EP sonographers in a critically ill patient population. ⋯ Parasternal long axis and PSSA are the preferred echocardiographic windows for EP estimation of LVEF using focused bedside TTE in critical care patients. This may be an important consideration in patients who often have physical barriers to optimal echocardiographic evaluation, are relatively immobile, and have unstable conditions requiring rapid assessment and intervention.
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Comparative Study
Utility of Stewart's strong ion difference as a predictor of major injury after trauma in the ED.
Base deficit (BD) is a validated surrogate for lactate in injured patients and correlates with trauma severity. Stewart proposed a more comprehensive measure of acidosis based on the strong ion difference (SID) (SID = Na + K + Mg + Ca - CL - lactate [mEq/L]). We compared operating characteristics of BD, anion gap (AG), and SID in identifying major injury in emergency department (ED) trauma patients. ⋯ Stewart's SID can identify major injury in the ED.