The American journal of emergency medicine
-
Randomized Controlled Trial Comparative Study Clinical Trial
Intraosseous is faster and easier than umbilical venous catheterization in newborn emergency vascular access models.
The purpose of this study is to compare the speed and ease of establishing newborn emergency vascular access using intraosseous (IO) versus umbilical venous catheterization (UVC). The study is an experimental design. A total of 42 medical students, without prior IO and UVC experience, were recruited as study subjects. ⋯ Although UVC may be preferred by neonatologists, this model suggests that IO results in easier and more rapid vascular access in those who do not frequently perform newborn resuscitation. As such, the benefit of teaching UVC in pediatric resuscitation courses should be reconsidered. The recommended method of emergency newborn vascular access should be reconsidered pending further studies on this subject.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of a new screw-tipped intraosseous needle versus a standard bone marrow aspiration needle for infusion.
The purpose of this study is to compare the speed and ease of establishing intraosseous infusion using a standard bone marrow needle (SBMN; $8) and a new screw-tipped intraosseous needle (Sur-Fast; $42). The study is an experimental design. A total of 42 medical students, without prior IO experience, were recruited as study subjects. ⋯ VAS difficulty scores were lower (easier) for the SBMN for both inexperienced and experienced trials. Success rates were significantly higher for the Sur-Fast needle during the experienced attempt (95% versus 79%, P < .05), but there was no significant difference in success rates during the inexperienced attempt. The Sur-Fast screw-tipped intraosseous needle does not show superiority over the SBMN in this intraosseous model, therefore its higher cost is difficult to justify based on this study.
-
Letter Randomized Controlled Trial Clinical Trial
The effect of introducing bedside TV sets on patient satisfaction in the ED.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Anesthetic methods for reduction of acute shoulder dislocations: a prospective randomized study comparing intraarticular lidocaine with intravenous analgesia and sedation.
A prospective, randomized, nonblinded clinical trial was undertaken to evaluate whether local intraarticular lidocaine injection (IAL) is equally effective in facilitating reduction of acute anterior shoulder dislocations (AASD) as intravenous analgesia/sedation (IVAS). The setting was an urban, Level 1, trauma center. Patients enrolled presented to the emergency department (ED) with radiographically confirmed AASD and were randomized either to the IVAS group or the IAL group. ⋯ However, with reduction rate evaluated as a function of time delay in seeking treatment, patients presenting 5.5 hours after dislocation were more likely to fail treatment with IAL (P = .00001). Additionally, half of the patients in the IAL group who had experience with IVAS did not favor IAL. Emergency physicians should be aware of IAL as an alternative technique that may be considered in patients when there are reasons to avoid systemic analgesia or sedation.
-
Randomized Controlled Trial Clinical Trial
The effectiveness of ice as a topical anesthetic for the insertion of intravenous catheters.
In a paired clinical trial, the effectiveness of ice in reducing the pain of intravenous catheter placement was assessed in 28 adult volunteers. An ice pack was placed over one arm for 10 minutes, followed by insertion of an 18-gauge angiocatheter in both arms. Patients recorded their pain assessment after each venipuncture on a previously validated 100-mm visual analog scale (VAS) and identified their preferred method for the procedure (pretreatment with ice or no pretreatment). ⋯ Most patients (61%) preferred no pretreatment (P = .014). Although most men (75%) preferred no pretreatment, 75% of women preferred pretreatment with ice (P = .014). Future studies should examine whether ice is effective at reducing pain from other more painful procedures and whether the response to ice is gender-related.