The American journal of emergency medicine
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Randomized Controlled Trial
Lidocaine gel as an anesthetic protocol for nasogastric tube insertion in the ED.
The aim of the study was to evaluate the efficacy of topical 2% lidocaine gel in reducing pain and discomfort associated with nasogastric tube insertion (NGTI) and compare lidocaine to ordinary lubricant gel in the ease in carrying out the procedure. ⋯ Lidocaine gel administered nasally 5 minutes before NGTI significantly reduces pain and gagging sensations associated with the procedure but is associated with more difficult tube insertion compared to the use of lubricant gel.
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Review Case Reports
A case of closed total dislocation of talus and literature review.
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The Centers for Disease Control and Prevention recommends routine HIV screening for adults. ⋯ The ED-based HIV testing is feasible within a Veterans Hospital Administration setting. Involvement of nursing in a community-based participatory research implementation model may facilitate staff acceptance of nontargeted HIV screening and be a mechanism to initiate administration of clinical preventive services to ED patients with limited primary care contact.
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Cutaneous abscesses have traditionally been treated with incision and drainage followed by secondary healing. Primary closure after incision and drainage is an alternative mode of therapy practiced in some parts of the world. The current study reviews the experience with primary closure of abscesses. ⋯ Studies from 4 countries suggest that primary closure of incised and drained abscesses results in faster healing and similar low abscess recurrence rates than after secondary closure. These studies provide a foundation for which clinical trials can be conducted in the United States.
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Emergency department (ED) chest pain protocols often include an exercise stress test (EST) in an outpatient setting to further risk stratify patients initially identified as low risk for acute coronary syndrome. Our goal was to characterize the noncompliant patient population and delineate reasons for uncompleted EST. ⋯ Our findings suggest lack of patient comprehension about purpose and logistics of EST completion. Based upon our data, the ED should confirm the appropriateness of the EST for each patient and improve patient communication and EST availability.