The American journal of emergency medicine
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Multicenter Study
Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters.
Obtaining intravenous (IV) access in the emergency department (ED) can be especially challenging, and physicians often resort to placement of central venous catheters (CVCs). Use of ultrasound-guided peripheral IV catheters (USGPIVs) can prevent many "unnecessary" CVCs, but the true impact of USGPIVs has never been quantified. This study set out to determine the reduction in CVCs by USGPIV placement. ⋯ Ultrasound prevented the need for CVC placement in 85% of patients with difficult IV access. This suggests that USGPIVs have the potential to reduce morbidity in this patient population.
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Randomized Controlled Trial
Clinical effects of adjunctive atropine during ketamine sedation in pediatric emergency patients.
The prophylactic coadministration of anticholinergics during dissociative sedation has been considered necessary to mitigate ketamine-associated hypersalivation. Given recent conflicting conclusions regarding adjunctive atropine, we compared the incidence of hypersalivation, degree of secretion, and related side effects with atropine or placebo as an adjunct to intravenous (IV) ketamine sedation for children. ⋯ Atropine as an adjunct to IV ketamine sedation in children significantly reduced hypersalivation, without providing a clinical benefit.
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Randomized Controlled Trial
Efficacy of high-flow oxygen therapy in all types of headache: a prospective, randomized, placebo-controlled trial.
We aimed to assess the efficacy of oxygen inhalation therapy in emergency department (ED) patients presenting with all types of headache. ⋯ In addition to its role in the treatment of cluster headache, high-flow oxygen therapy may provide an effective treatment of all types of headaches in the ED setting.
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Randomized Controlled Trial
External laryngeal manipulation does not improve the intubation success rate by novice intubators in a manikin study.
External laryngeal manipulation (ELM) is a technique used in cases of poor glottic view in direct laryngoscopy. Studies investigating ELM in the pediatric population are lacking. The objective of this study was to examine if use of ELM by inexperienced intubators improves the success rate of pediatric intubation. ⋯ In this pediatric manikin study, ELM performed by novice intubators improved laryngeal view, but lengthened the duration of intubation and did not improve intubation success rate.
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Randomized Controlled Trial
Intravenous contrast alone vs intravenous and oral contrast computed tomography for the diagnosis of appendicitis in adult ED patients.
When the diagnosis of appendicitis is uncertain, computerized tomography (CT) scans are frequently ordered. Oral contrast is often used but is time consuming and of questionable benefit. This study compared CT with intravenous contrast alone (IV) to CT with IV and oral contrast (IVO) in adult patients with suspected appendicitis. ⋯ Computerized tomography scans with intravenous contrast alone have comparable diagnostic performance to IVO scans for appendicitis in adults. Patients receiving IV scans are discharged from the ED faster than those receiving IVO scans.