The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study
Ibuprofen vs acetaminophen vs their combination in the relief of musculoskeletal pain in the ED: a randomized, controlled trial.
Non-opioid analgesics are often administered to emergency department (ED) patients with musculoskeletal pain but if inadequate, opioids are given with associated potential adverse events. We tested the hypothesis that the reduction in pain scores with the combination of ibuprofen and acetaminophen would be at least 15 mm greater than with either of the agents alone. We conducted a double-blind, randomized, controlled trial of adult ED patients with acute musculoskeletal pain. ⋯ However, there was no significant difference among treatments (P = .59). The need for rescue analgesics was similar across groups. We conclude that the combination of ibuprofen and acetaminophen did not reduce pain scores or the need for rescue analgesics compared with either agent alone in ED patients with pain secondary to acute musculoskeletal injuries.
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One of the most used methods to evaluate patients with a high risk not responding to clinical treatment is the measurement of blood levels of lactic acid (LA). The objective of this study was to compare the sensitivity and specificity of an LA test for capillary and venous blood with LA test for arterial blood in a population of patients with tissue hypoperfusion and to evaluate the time needed for each test. ⋯ The utilization of capillary and venous LA is an effective method of evaluation and risk stratification for patients with different degrees of tissue hypoperfusion. The time needed to elicit capillary LA proved much faster with respect to arterial and venous LA.
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We sought to evaluate the added value of ultrasensitive copeptin (us-copeptin) for early rule out of acute myocardial infarction in a prospective cohort of emergency department (ED) patients with acute chest pain. ⋯ Assessment of us-copeptin combined with hs-cTnT on ED admission could allow safe and early rule out of NSTEMI for patients with negative results on both markers and help identify patients who may be suitable for discharge.
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Multicenter Study
Factors associated with successful second and third intubation attempts in the ED.
The aim of this study was to identify the factors associated with successful second and third attempts in adults following a failed first intubation attempt in the emergency department (ED). ⋯ Nondifficult airway and the use of RSI were associated with successful second and third intubation attempts. The use of RSI, backup by experienced senior physicians, and preparation for management of a difficult airway could be strategies for successful rescue intubation attempts in the ED.
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The purpose of this study is to determine whether point-of-care (POCT) urinalysis (UA) is as accurate as laboratory-performed UA in diagnosing urinary tract infections (UTIs) in the pediatric emergency department (PED). ⋯ Although POCT UAs offer more rapid turnaround times, the sensitivity is greater for laboratory-performed UAs. Given the difficulty in following up PED patients after discharge as well as the potential morbidity from untreated UTIs, the rapidity of the POCT UA must be balanced against the lower sensitivity of this assay. The benefit of more accurate diagnosis may outweigh the potentially longer PED length of stay associated with a laboratory-performed UA.