The American journal of emergency medicine
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Review Meta Analysis
Impact of personal protective equipment on the effectiveness of chest compression - A systematic review and meta-analysis.
To assess the impact of personal protective equipment (PPE) on different aspects of chest compression (CC) during cardiopulmonary resuscitation, we conducted this study. ⋯ The use of PPE compromises the quality of CC during CPR significantly, and newer ways to deliver chest compression has to be investigated. This study was prospectively registered in PROSPERO (CRD42020192031).
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Review Meta Analysis
Diagnostic modalities to determine ventriculoperitoneal shunt malfunction: A systematic review and meta-analysis.
Ventriculoperitoneal (VP) shunt malfunction is an emergency. Timely diagnosis can be challenging because shunt malfunction often presents with symptoms mimicking other common pediatric conditions. ⋯ Despite the low sensitivity, a positive shunt series obviates the need for further imaging studies. Prompt referral for neurosurgical intervention is recommended. A negative shunt series or any result (positive or negative) from CT, MRI, or ONSD will still require an emergent neurosurgical referral.
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Comparative Study
Intravenous acetaminophen does not have an opioid sparing effect in Emergency Department patients with painful conditions.
Pain in the Emergency Department is common and is frequently treated with opioids. Due to the opioid epidemic, it is clinically helpful to decrease opioid usage. The purpose of this study was to evaluate opioid requirement in Emergency Department patients with painful conditions who receive intravenous acetaminophen. ⋯ The additional use of intravenous acetaminophen did not decrease opioid requirement in adult patients with acute pain during Emergency Department stay. There was a trend towards decreased opioid requirement during 24 h after discharge.
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Review Case Reports
Emergency department approach to gastric tube complications: A case report and review of the literature.
Nasogastric and orogastric tubes (NGT/OGT) are commonly used in emergency and critical care settings, with indications including medicinal administration, gastric decompression, and enteral feeding. Previous studies have highlighted a variety of complications associated with tube placement. These range from minor occurrences such as nose bleeds and sinusitis, to more severe cases highlighting tracheobronchial perforation, tube knotting, asphyxia, pulmonary aspiration, pneumothorax, and even intracranial insertion. ⋯ Here we present a case involving a 60-year-old male who was brought to the ED and suffered a right sided pneumothorax (PTX) following improper OGT placement. In this case, air insufflation was utilized, but was ineffective in detecting the properly placed tube; leakage of an endotracheal tube cuff served as a lead for misplacement while imaging was conducted. The purpose of this study is not only to highlight the numerous complications that are possible with NGT and OGT placement, but also to propose the use of multiple bedside tests (pH testing, CO2 detection, POCUS) as an alternative to radiographic imaging to increase sensitivity and specificity for detection of improperly placed tubes.