The American journal of emergency medicine
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Randomized Controlled Trial
Accuracy of Trans-Abdominal Ultrasound in a Simulated Massive Acute Overdose.
Toxic ingestions are a common cause of morbidity and mortality in the United States. In 2013, there were nearly 2 million reported ingestions and nearly 1000 deaths from poisonings. There is no well-validated imaging study for confirming the presence of pills in the stomach of an overdose patient. There are case reports of ultrasound used for confirmation of pills in the stomach, and we are aware of one prospective trial to evaluate sonography for this application. ⋯ There is poor sensitivity and specificity for ultrasound detection of pills in the stomach at time 0; these values fell substantially at 60 and 90 minutes post-ingestion. In this pilot study, we did not find ultrasound to be a useful screening tool for detecting pills in the stomach.
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Review Meta Analysis
Failure of antibiotics in cellulitis trials: a systematic review and meta-analysis.
The objectives of the study are to quantify trial-to-trial variability in antibiotic failure rates, in randomized clinical trials of cellulitis treatment and to provide a point estimate for the treatment failure rate across trials. ⋯ Treatment failure rates vary widely across cellulitis trials, from 6% to 37%. This may be due to confusion of cellulitis with its mimics and perhaps problems with construct validity of the diagnosis of cellulitis. Such factors bias trials toward equivalence and, in routine clinical care, impair quality and antibiotic stewardship. Objective diagnostic tools are needed.
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Randomized Controlled Trial Multicenter Study
Ketoprofen gel improves low back pain in addition to intravenous dexketoprofen: a randomized placebo-controlled trial.
Oligoanalgesia is common in emergency departments (EDs), and pain management is of concern for ED physicians. The aim of this study was to reveal the effect of ketoprofen gel in patients presenting with mechanical low back pain to the ED. ⋯ Ketoprofen gel improves pain in patients presenting with mechanical low back pain to ED at 30 minutes in addition to intravenous dexketoprofen when compared to placebo.
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Multicenter Study Observational Study
Routine biological tests in self-poisoning patients: results from an observational prospective multicenter study.
Routine biological tests are frequently ordered in self-poisoning patients, but their clinical relevance is poorly studied. ⋯ Routine biological tests are commonly prescribed in nonsevere self-poisoning patients. Abnormal results are frequent but their relevance at bedside remains limited.
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Although cardiac stress testing may help establish the safety of early discharge in patients with suspected acute coronary syndromes and negative troponins, more cost-effective strategies are necessary. We aimed to develop a clinical prediction rule to safely obviate the need for cardiac stress testing in this setting. ⋯ This novel prediction rule based on a combination of readily available clinical characteristics may be a valuable tool to decide whether stress testing can be reliably avoided in patients with acute chest pain and negative troponins.