The American journal of emergency medicine
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Randomized Controlled Trial
Intravenous contrast alone vs intravenous and oral contrast computed tomography for the diagnosis of appendicitis in adult ED patients.
When the diagnosis of appendicitis is uncertain, computerized tomography (CT) scans are frequently ordered. Oral contrast is often used but is time consuming and of questionable benefit. This study compared CT with intravenous contrast alone (IV) to CT with IV and oral contrast (IVO) in adult patients with suspected appendicitis. ⋯ Computerized tomography scans with intravenous contrast alone have comparable diagnostic performance to IVO scans for appendicitis in adults. Patients receiving IV scans are discharged from the ED faster than those receiving IVO scans.
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Randomized Controlled Trial
A randomized controlled trial of adding intravenous pantoprazole to conventional treatment for the immediate relief of dyspeptic pain.
Acute, severe dyspeptic pain is a common condition in the emergency department. Despite the traditional "GI cocktail" (GI indicates gastrointestinal), an intravenous (IV) proton pump inhibitor (PPI), a novel acid-lowering drug, has recently been used to treat this condition. The aim of this study was to evaluate the immediate effect of IV pantoprazole in addition to the conventional GI cocktail in the relief of severe dyspeptic pain. ⋯ Intravenous PPI provides no additional benefit over the conventional GI cocktail in the relief of acute, severe dyspeptic pain. Because of its neutral effect and higher cost, the use of IV PPI to treat such conditions should be discouraged in general clinical practice.
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Randomized Controlled Trial
Clinical effects of adjunctive atropine during ketamine sedation in pediatric emergency patients.
The prophylactic coadministration of anticholinergics during dissociative sedation has been considered necessary to mitigate ketamine-associated hypersalivation. Given recent conflicting conclusions regarding adjunctive atropine, we compared the incidence of hypersalivation, degree of secretion, and related side effects with atropine or placebo as an adjunct to intravenous (IV) ketamine sedation for children. ⋯ Atropine as an adjunct to IV ketamine sedation in children significantly reduced hypersalivation, without providing a clinical benefit.
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Randomized Controlled Trial
Efficacy of high-flow oxygen therapy in all types of headache: a prospective, randomized, placebo-controlled trial.
We aimed to assess the efficacy of oxygen inhalation therapy in emergency department (ED) patients presenting with all types of headache. ⋯ In addition to its role in the treatment of cluster headache, high-flow oxygen therapy may provide an effective treatment of all types of headaches in the ED setting.
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Randomized Controlled Trial
Chest compressions performed by ED staff: a randomized cross-over simulation study on the floor and on a stretcher.
Multiple factors may contribute to the observed survival variability following in-hospital cardiopulmonary resuscitation (CPR). While in-hospital CPR is most often performed on patients lying on a bed or stretcher, CPR training uses primarily manikins placed on the floor. We analyzed the quality of external chest compressions (ECC) in simulated cardiac arrest scenarios occurring both on a stretcher and on the floor. ⋯ The quality of chest compressions performed by ED staff was below 2005 guideline standards, with decreased ECC depth during CPR on a stretcher. Annual refresher courses should be implemented in the ED, with a focus on obtaining required ECC depth while standing next to a stretcher.