Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Influenza outbreaks have been associated with worsened emergency department (ED) crowding. We sought to examine the mechanism behind this association. ⋯ Influenza season is associated with increased ED utilization by patients aged 65 years and older, most of whom have major respiratory illnesses and may require hospital admission. No association was seen between influenza and utilization by younger patients. Efforts to reduce the impact of influenza seasons on EDs should focus on elders.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of oxycodone and hydrocodone for the treatment of acute pain associated with fractures: a double-blind, randomized, controlled trial.
Previous studies have demonstrated the efficacy of oxycodone and hydrocodone for the treatment of acute pain. However, to the best of the authors' knowledge, no previous reports have compared the efficacies of these commonly prescribed agents. ⋯ Treatment with acetaminophen and either oxycodone, 5 mg po, or hydrocodone, 5 mg po, resulted in pain relief among ED patients with acute fractures, and there was no difference between the two agents at 30 and 60 minutes. Adverse effect profiles were similar, with the exception of a higher incidence of subsequent constipation with the use of hydrocodone. These results suggest that oxycodone and hydrocodone have similarly potent analgesic effects in the first hour of treatment for ED patients with acute fractures.
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Randomized Controlled Trial Clinical Trial
Ultrasound with topical anesthetic rapidly decreases pain of intravenous cannulation.
Physicians and nurses in the emergency department rarely use topical anesthesia when starting intravenous (IV) lines because of time constraints and lack of data on patients' perception of the pain associated with this procedure. Ultrasound pretreatment of skin increases permeation rates of hydrophobic topical medications, including topical lidocaine. The objective of this study was to demonstrate that ultrasound treatment followed by brief application of topical anesthetic decreases the patients' perception of the pain of IV cannulation. ⋯ The SonoPrep ultrasound device applied to skin for 15 seconds followed by 5 minutes of 4% liposomal lidocaine cream significantly reduced patients' perception of the pain of an IV start when compared with standard care. There were no adverse side effects noted in any participant during the 36 hours of the follow-up period.
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Randomized Controlled Trial Clinical Trial
Bladder ultrasound increases catheterization success in pediatric patients.
To determine whether volumetric bladder ultrasound (VBUS) determinations improve the rate of successful pediatric catheterizations and caregiver satisfaction. ⋯ Although there was no significant difference in caregiver satisfaction between the VBUS and CC groups, implementation of VBUS greatly improved the success rates of pediatric emergency department catheterizations. This improvement is achieved with a rapid and easily mastered VBUS technique.
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To determine the prevalence of hip and pelvic fractures in emergency department (ED) patients with hip pain and negative standard initial radiographs. ⋯ In this cohort of ED patients with symptoms suspicious for hip fracture who had negative standard radiographs, the authors found that 4.4% were subsequently diagnosed as having fracture. Further studies are warranted to identify characteristics of patients requiring advanced hip imaging studies.