The American journal of emergency medicine
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Treatment of pain in the emergency department (ED) is a significant area of focus, as previous studies have noted generally inadequate treatment of pain in ED patients. Previous studies have not evaluated the impact of computerized physician order entry (CPOE) on the treatment of pain in the ED. We sought to evaluate treatment of pain before and after implementation of CPOE in an academic ED. ⋯ The use of CPOE in the ED may offer modest benefits in the treatment of patients with pain-related complaints.
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Limited recommendations address empiric versus delayed treatment of pediatric patients for sexually transmitted infections (STIs). This study investigates how frequently empiric STI treatment correlated with subsequent positive test results in an urban, high-risk pediatric emergency department (PED). ⋯ Providers in high-risk pediatric populations with unreliable patient follow-up should consider having a low threshold for empiric treatment. Development of clinical decision rules and/or strategies to improve patient follow-up may help optimize empiric STI treatment decisions in the PED.
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Hypovolemic shock is an important cause of death in the emergency department (ED). We sought to conduct a meta-analysis to quantify existing evidence on sonographic measurement of inferior vena cava (IVC) diameter in assessing of volume status adult ED patients. ⋯ Moderate level of evidence suggests that the IVC diameter is consistently low in hypovolemic status when compared with euvolemic. Further blinded studies are needed before it could be used in the ED with confidence.
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Clinical Trial
The effect of bedside ultrasound on diagnosis and management of soft tissue infections in a pediatric ED.
Presentation of skin and soft tissue infections (SSTIs) to the pediatric emergency department (PED) has increased. Physical examination alone can be inadequate in differentiating cellulitis from an abscess. The purposes of this study were to determine the effect of bedside ultrasound (US) in improving diagnostic accuracy for SSTIs in the PED and to evaluate its effect on the management of patients with SSTIs. ⋯ Emergency department bedside US improves accuracy in diagnosis of SSTIs. Bedside US changes management in a small but significant number of patients with SSTIs.