The American journal of emergency medicine
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Randomized Controlled Trial Clinical Trial
Nursing use between 2 methods of procedural sedation: midazolam versus propofol.
We compared propofol (P) and midazolam (M) use in sedation using nurses' (RN's) monitoring times, costs, and visual analog scale (VAS) satisfaction scores. We randomized 40 patients to either P or M groups. The P group received 0.5 mg/kg IV followed by titration to a Ramsay Sedation Scale of 3 or 4. ⋯ VAS score differences were significant only in the physician group. We concluded that compared with midazolam, propofol required less RN monitoring and had lower costs. Physician satisfaction was higher with propofol sedation than with midazolam and required less time.
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The etiology of dyspnea can often be difficult to rapidly and accurately determine and can delay timely and appropriate therapies. The current literature reveals important diagnostic, prognostic, and therapeutic implications of several currently used biomarkers: sensitive d -dimer, myoglobin, creatine kinase-MB, cardiac troponins, and b-type natriuretic peptide. These biomarkers were found to have a high sensitivity and negative predictive value for rapidly ruling out potential serious etiologies of dyspnea, namely, pulmonary embolism (PE), acute myocardial infarction (AMI), and congestive heart failure (CHF). ⋯ A dyspnea biomarker panel could rapidly and accurately assist a clinician to rule out PE, AMI, and CHF. If a PE, AMI, or CHF is determined to be the cause of dyspnea, a biomarker panel could help risk stratify and help determine initial therapies. Subsequent clinical research is needed to corroborate this postulation.
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Comparative Study
Aspiration of gastric contents: association with prehospital intubation.
We prospectively compared the incidence of pulmonary aspiration of gastric contents between patients endotracheally intubated in the prehospital (PH) setting and those intubated in the emergency department (ED). Tracheal aspirates were collected using a standard Leukens trap from all patients as soon as possible after endotracheal intubation. ⋯ The pepsin assay was positive in 10 of 20 (50%) patients intubated in the PH group, as opposed to 33 of 148 (22%) of those intubated in the ED (chi2 P=.008; odds ratio, 3.5; 95% CI, 1.34-9.08). Patients endotracheally intubated in the PH setting are more likely to have aspirated gastric contents than those intubated in the ED.
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Multicenter Study
Home modification to prevent falls by older ED patients.
This trial was conducted at 11 EDs to test the effectiveness of distributing fall prevention information to patients 65 years or older. Intervention patients were given 2 brochures and received a reminder call 2 weeks later. All patients were called at 1 month and asked if they made home safety modifications. ⋯ Patients who fell in the prior year had a 2.0 increased odds (95% confidence interval, 0.8-4.6) of making a home modification. The similar home modification rates in the 2 study groups suggest that even minimum discussion (eg, the informed consent procedure) may increase patients' fall prevention activities. The stronger association in patients who fell suggests that a targeted program may have added benefit.
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Randomized Controlled Trial Clinical Trial
Cardiovascular responses in patients with acute allergic reactions treated with parenteral epinephrine.
The present study describes the cardiovascular responses to epinephrine (Epi) given into the arm, in adult patients with acute allergic reactions, and the differential responses to subcutaneous (SC) and intramuscular (IM) administration. Sixty-three adult patients were treated with Epi administered SC or IM after H1 and H2 receptor blockade. Heart rate and blood pressure (BP) were then measured for 20 minutes. ⋯ In conclusion, adults with acute allergic syndromes treated with arm-injected Epi show a modest but definite increase in pulse pressure and systolic BP. This pattern is observed more in males. Heart rate and blood pressure differences between IM and SC arm-injected Epi treatments do not appear to be significant.