The American journal of emergency medicine
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Randomized Controlled Trial
Prospective, randomized, double-blind controlled trial comparing vapocoolant spray vs placebo spray in adults undergoing venipuncture.
Topical anesthetics are used to decrease procedural pain such as venipuncture. Advantages of vapocoolants include rapid onset, ease of application, low cost, and lack of associated pain of injection and other needlestick-related risks. We hypothesized that the pain of venipuncture would be reduced by at least 1.8 points on a 10-point numerical rating scale after application of a vapocoolant compared with placebo. ⋯ The vapocoolant significantly decreased venipuncture pain in adults compared with placebo and was well tolerated with minor adverse effects that resolved quickly. There were no significant differences in VS and no visible skin changes documented at the site by photographs taken within 5 to 10 minutes postspray/venipuncture.
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Meta Analysis Comparative Study
Effects of long axis in-plane vs short axis out-of-plane techniques during ultrasound-guided vascular access: preliminary evidence.
Currently, whether long-axis in-plane (LA-IP) is superior to short-axis out-of-plane (SA-OOP) during ultrasound-guided vascular access remains inconclusive. We, therefore, conducted a meta-analysis of randomized controlled trials to compare the effects of LA-IP vs SA-OOP techniques in patients undergoing ultrasound-guided vascular access (USGVA). ⋯ There is insufficient evidence to definitively choose either LA-IP or SA-OOP in patients undergoing USGVA. Further robustly well-designed trials are warranted to investigate the appropriate technique in patients receiving USGVA.
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Randomized Controlled Trial
Topical ethyl chloride to reduce pain associated with venous catheterization: a randomized crossover trial.
To compare pain associated with venous catheterization after administration of topical ethyl chloride vs placebo among emergency department health care providers. ⋯ We found that topical ethyl chloride yields a greater reduction in pain associated with venous catheterization compared with topical placebo.
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Randomized Controlled Trial
The effect of nebulized magnesium sulfate in the treatment of moderate to severe asthma attacks: a randomized clinical trial.
Thirty percent of people with asthma do not respond to standard treatment, and complementary therapies are needed. The objective of this study was to investigate the impact of inhaled magnesium sulfate on the treatment response in emergency department (ED) patients with moderate to severe attacks of asthma. ⋯ Adding nebulized magnesium sulfate to standard therapy in patients with moderate to severe asthma attacks leads to greater and faster improvement in PEFR, respiratory rate, oxygen saturation and respiratory rate. It also reduces hospitalization rates in this patient population.
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We discuss a case of a 20-year-old woman presenting with chest pain found to have a Hampton's hump on chest x-ray and corresponding wedge infarct on computed tomographic scan. Contrary to our suspicion that this febrile and tachycardic patient had a pulmonary embolism, she was later determined to have a septic embolus secondary to endocarditis. We highlight the difficulties in diagnosing certain cases of endocarditis in the emergency department, as well as the difficulties in distinguishing septic emboli from pulmonary emboli,especially with plain radiographs.