The American journal of emergency medicine
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Randomized Controlled Trial Clinical Trial
Efficacy of superactivated charcoal administered late (3 hours) after acetaminophen overdose.
The purpose of this study was to investigate the effect of superactivated charcoal (SAC) given late after a drug overdose. Acetaminophen was chosen as our overdose drug because it has relatively few side effects, serum levels are easily attainable and measurable, and it is generally a common drug overdose. Forty-six healthy adult volunteers participated in this randomized, controlled study. ⋯ Serum acetaminophen levels were measured at 4 and 7 hours after the initial acetaminophen administration. There were significantly lower uncorrected and corrected acetaminophen levels in the SAC group compared with the control group at both 4 and 7 hours after ingesting acetaminophen. This randomized human experimental design trial demonstrates some detoxification benefit in administering superactivated charcoal 3 hours after an overdose.
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Review
A novel use of the endocavity (transvaginal) ultrasound probe: central venous access in the ED.
Use of ultrasound (US) to obtain intravenous access is usually accomplished with a 7.5-MHz linear US probe. This paper describes the use of an endocavity US probe to obtain vascular access. Since both probes use US of the same megahertz values, the picture quality with the two is no different. Because the equipment used for each type of probe costs thousands of dollars, the economic value of having to purchase one less probe may be significant.
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Randomized Controlled Trial Clinical Trial
Bedside ultrasound to determine prandial status.
The prandial status of ED patients is often unknown. Because a full stomach predisposes patients to aspiration during a variety of urgent interventions, a method of determining the degree of gastric fullness would be of potential clinical importance. The purpose of this single-blind interventional trial was to determine if bedside ultrasound, performed by EPs, could accurately determine prandial status. ⋯ We found that the technique was specific in identifying a full stomach but only moderately reliable in identifying an empty one. Best results (sensitivity S + 86%, specificity S- 70%, accuracy A+ 78%) were achieved only after water ingestion with the patient in the RLD position. We conclude that bedside ultrasound is of only limited value for determining prandial states in the ED setting.
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Clinical Trial
Diagnostic utility of echocardiography in patients with suspected pulmonary embolism.
The aim of this study was to investigate the clinical utility of echocardiography in the diagnosis of pulmonary embolism (PE). For this, we enrolled 162 patients with suspected PE in a prospective study. We evaluated the sensitivity and specificity of right ventricular dilatation, the Doppler evidence of pulmonary hypertension, and their possible associations. ⋯ Adding echocardiography to the diagnostic strategy for PE would avoid about 12 to 28% of lung-scan angiography procedures, but would cause inappropriate treatment of 4 to 14% of all treated patients. The clinical utility of echocardiography in the diagnosis of PE is limited. The reduction in the number of standard diagnostic procedures obtained through its use would be counterbalanced by an excess of patients inappropriately treated.
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Comparative Study Clinical Trial
Pigtail tube drainage in the treatment of spontaneous pneumothorax.
We report our experience in using pigtail tube drainage in the treatment of spontaneous pneumothorax compared with traditional chest tube thoracotomy. One hundred two patients were included and analyzed. Fifty patients were treated with the pigtail tube and 52 patients were treated with the traditional chest tube. ⋯ Among the chest tube group, 15 underwent surgical intervention as a result of delayed resolution and hemopneumothorax; and among the pigtail group, 15 had other procedures for pneumothorax, including chest tube insertion and surgical intervention. This verifies our initial suspicion that the effectiveness of the pigtail drainage system is no less than that of the chest tube. Therefore, when considering ambulatory ability and good patient compliance, the pigtail tube drainage system can be considered as the treatment of choice for spontaneous pneumothorax.