Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The assessment of pre-procedure fasting and control of sedation depth are prominent elements of widely disseminated procedural sedation guidelines and of the Joint Commission on Accreditation of Healthcare Organizations' standards. Both exist primarily to minimize the risk of pulmonary aspiration of gastric contents. This paper critically examines the literature on pre-procedure fasting and controlling sedation depth in association with pulmonary aspiration, and interprets this evidence in the context of modern emergency medicine practice. ⋯ It is noted that aspiration during ED PSA has not been reported in the medical literature and that aspiration during general anesthesia and labor and delivery is uncommon. The literature provides no compelling evidence to support specific fasting periods for either liquids or solids prior to PSA, and existing guidelines for elective patients are of necessity arbitrary and based upon consensus opinion. The article discusses the implications in the areas of training and preparedness, monitoring, and research for the emergency physician practicing PSA.
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Comparative Study
Parental use and misuse of antibiotics: are there differences in urban vs. suburban settings?
To compare the frequencies with which suburban and urban parents give their children antibiotics without first consulting a physician. ⋯ Parents in the suburban setting were more likely to have misused antibiotics for their children. On the other hand, parents in the urban setting were more likely to have been discharged by a physician at one health facility and gone to another physician's office or ED in order to obtain antibiotics for their children.
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To describe the testing requirements and practices of emergency physicians (EPs) when conducting a medical screening examination of psychiatric patients. ⋯ Routine testing was required as part of the medical screening examination of psychiatric patients for only one-third of the respondents. Few respondents believed that any of these tests were necessary. Emergency medicine-trained physicians were less likely to feel that routine testing was necessary.
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Significant benefit could be realized by developing a clinical decision rule for new-onset seizure victims that would be capable of discriminating between patients having relevant structural lesions visible on computed tomographic (CT) imaging and those who do not. This study sought to determine whether a reliable decision rule could be developed using a limited number of clinical and demographic characteristics. ⋯ Recursive partitioning failed to produce a decision rule capable of reliably identifying new-onset seizure patients who have important lesions identified on CT. Future attempts to formulate such an instrument may need to include additional variables. In the interim, physicians should use liberal tomographic imaging in evaluating patients who present with new-onset seizures.
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Comparative Study
Hyperbaric oxygen does not prevent neurologic sequelae after carbon monoxide poisoning.
Delayed neurologic sequelae occur in up to 40% of severe carbon monoxide (CO) poisonings. Conflicting clinical data support the efficacy of hyperbaric oxygen (HBO) therapy in the acute treatment of CO poisoning. ⋯ These results suggest that HBO is not effective in preventing neurologic sequelae in mice and that there is no benefit of HBO over NBO following severe CO neurotoxicity.