The American journal of emergency medicine
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Randomized Controlled Trial
A sequential, multiple-assignment, randomized trial of analgesic strategies for acute musculoskeletal Pain.
Most methodologically rigorous, ED-based, comparative effectiveness analgesic studies completed in the last two decades failed to find a clinically important difference between the comparators. We believe that many of these comparative effectiveness studies were biased towards the null hypothesis because some ED patients with intense pain will respond to relatively mild interventions. We hypothesized that including a run-in period would alter the results of an acute pain RCT. ⋯ Among patients with acute musculoskeletal pain, using an acetaminophen first strategy did not alter pain outcomes.
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Randomized Controlled Trial
Tourniquet application in time-critical aquatic emergencies on a moving rescue water craft (RWC): Can speed and precision coexist?
Lifeguards are the first responders to any type of aquatic incident, including rapid rescue situations such as boating and sporting accidents, animal bites/attacks, and cases involving massive bleeding. In their line of work, rescue boats such as Rescue Water Craft (RWC) are commonly utilized the aim of this study is to evaluate the time and technique of placing a tourniquet on the sled of an RWC navigating at full speed. ⋯ The placement of a tourniquet on a RWC navigating at 20 knots is feasible, relatively quick, and technically well executed.
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Dengue is an arbovirus transmitted by the Aedes spp. mosquito. Approximately 390 million infections occur annually per World Health Organization estimates, with significant increases in infections throughout the last decade. ⋯ Patients experience a wide variety of symptoms ranging from asymptomatic infection to severe disease requiring critical care. Emergency clinicians should consider the diagnosis of dengue in patients from endemic areas presenting with a flu-like illness, rash, and evidence of bleeding.
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Observational Study
Suctioning in the management of bronchiolitis: A prospective observational study.
Bronchiolitis accounts for a considerable number of Emergency Department (ED) visits by infants each year and is the leading cause of respiratory infection in children 2 years of age and younger. Suctioning remains one of the main supportive treatments, but suctioning practices of nasal aspiration and deep suctioning vary among practitioners in bronchiolitis management. Our objective was to explore associations between suction type and respiratory distress, oxygen saturation, and markers of respiratory compromise such as airway escalation, disposition, ED length of stay (LOS), and outpatient outcomes. ⋯ There was no difference in respiratory scores or outpatient outcomes between suction types. Deep suctioning may not be needed in all infants with bronchiolitis.
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To investigate the cost-avoidance associated with implementation of an overnight emergency medicine pharmacist (EMP) through documented clinical interventions. ⋯ Expanded overnight coverage by EMPs provided clinical bedside pharmacotherapy expertise to critically ill patients otherwise not available prior to study implementation. Clinical interventions were associated with substantial cost-avoidance.