The American journal of emergency medicine
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Comparative Study
Comparing posteroanterior with lateral and anteroposterior chest radiography in the initial detection of parapneumonic effusions.
It is unclear whether anteroposterior (AP) or posteroanterior with lateral (PA/Lat) chest radiographs are superior in the early detection of clinically relevant parapneumonic effusions (CR-PPEs). The objective of this study was to identify which technique is preferred for detection of PPEs using chest computed tomography (CCT) as a reference standard. ⋯ PA/Lat chest radiography should be the initial imaging of choice in pneumonia patients for detection of PPEs because it appears to be statistically superior to AP chest radiography.
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The purposes of this study were to measure the chest wall thicknesses (CWTs) at second intercostal space (ICS) mid-clavicular line (MCL) and fifth ICS MAL directly, and compare the actual success rates of needle thoracostomies (NTs) by inserting a 5-cm-long syringe needle. Predictive values of weight, body mass index (BMI) and CWT were also analyzed. ⋯ In this report, we present the largest cadaver-based cohort to date to the best of our knowledge, and we observed a statistically nonsignificant 9% more NT success rate at 2nd ICS at a power of 88% and statistically significant more success rate in males at 5th ICS was (47.7%). We also observed thinner CWTs and higher success rates than previous imaging-based studies. A BMI of 23 kg/m2 or less and weight of 72 kg or less seem to accurately rule-out NT failure in cadavers, and they seem to be better predictors at the bedside.
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Observational Study
Has the rescheduling of hydrocodone changed ED prescribing practices?
The objective was to examine the effect of hydrocodone-containing product (HCP) rescheduling on the proportion of prescriptions for HCPs given to patients discharged from the emergency department (ED). ⋯ Rescheduling HCPs from Schedule III to Schedule II led to a substantial decrease in HCP prescriptions in our ED and an increase in prescriptions for other Schedule III and non-Schedule II/III products.
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In this study, we aimed to identify oxidative stress and the disruption in the oxidant-antioxidant balance in the acute phase of stroke and, therefore, to detect markers that will guide in the diagnosis and treatment of stroke. ⋯ It was seen that oxidant-antioxidant balance was impaired in favor of oxidants in ACI and AIH. In addition, impairment in oxidant-antioxidant balance was found in the early stages of ACI. Therefore, these biomarkers can be used especially in the early diagnosis of thrombolytic therapy candidates in ACI.
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Studies suggest that collaborative nursing protocols initiated in triage improve emergency department (ED) throughput and decrease time to treatment. ⋯ Emergency department triage pain protocol decreased time to provision of pain medications and did so without respect to payer category, sex, or race.