The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Valdecoxib does not impair platelet function.
The platelet effects of a supratherapeutic dose of the new cyclooxygenase (COX)-2 specific inhibitor, valdecoxib (40 mg twice a day), naproxen 500 mg twice a day, diclofenac 75 mg twice a day, and placebo were compared in 62 healthy adult subjects in this 7(1/2) day single-center, randomized, placebo-controlled trial. Platelet aggregation responses (to arachidonate [AA], collagen, and adenosine diphosphate [ADP]), bleeding time, and serum thromboxane B(2) (TxB(2)) concentrations were measured at baseline and at regular intervals on days 1 and 8. Valdecoxib had no effect on platelet function. ⋯ Naproxen significantly lowered serum TxB(2) levels. In contrast to standard doses of 2 nonsteroidal antiinflammatory drugs (NSAIDs), a supratherapeutic valdecoxib dosage does not impair platelet function (COX-1). Valdecoxib may be a safer analgesic option than conventional NSAIDs in patients for whom bleeding complications are a concern. (Am J Emerg Med 2002;20:275-281.
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Hypothermia is generally defined as a core body temperature less than 35 degrees C (95 degrees F). Hypothermia is one of the most common environmental emergencies encountered by emergency physicians. Although the diagnosis will usually be evident after an initial check of vital signs, the diagnosis can sometimes be missed because of overreliance on normal or near-normal oral or tympanic thermometer readings. ⋯ Hypothermia can also blunt the expected ECG findings associated with hyperkalemia. A thorough knowledge of these findings is important for prompt diagnosis and treatment of hypothermia. Six cases are presented that show these important ECG manifestations of hypothermia.
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Clinical Trial Controlled Clinical Trial
The effects of a physician-nurse patient care team on patient satisfaction in an academic ED.
The objectives were to investigate the effects of a RN/MD patient care team operational change on ED patient satisfaction. In period 1, RNs had standard room assignments and MDs evaluated patients based upon physician availability and perceived patient load. In period 2, RNs and MDs were organized into 2 patient care "teams" and patients were assigned to teams on an alternating basis. ⋯ Satisfaction with waiting time to see the physician also improved from the 25th to the 62nd percentile (67.6 +/- 32.2% v 73.4 +/- 28.5%, P
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We describe the prevalence of cognitive impairment in a population aged 65 and older requiring urgent medical services and to propose global evaluation, involving cognitive, functional and social aspects, during the emergency department (ED) visit to define an individualized care protocol. A total of 150 patients aged 65 and older attended at the ED were screened for cognitive impairment using the Mini-Mental State Examination (MMSE). ⋯ In no case of mild impairment had a cognitive deficit already been diagnosed. The functional and socioeconomic profile enabled proposing a strategy for better management of the patients discharged by the ED.