Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Small bowel obstruction (SBO) is a clinical condition that is often initially diagnosed and managed in the emergency department (ED). The high rates of potential complications that are associated with an SBO make it essential for the emergency physician (EP) to make a timely and accurate diagnosis. ⋯ The potentially useful aspects of the history and physical examination were limited to a history of abdominal surgery, constipation, and the clinical examination findings of abnormal bowel sounds and abdominal distention. CT, MRI, and US are all adequate imaging modalities to make the diagnosis of SBO. Bedside US, which can be performed by EPs, had very good diagnostic accuracy and has the potential to play a larger role in the ED diagnosis of SBO. More ED-focused research into this area will be necessary to bring about this change.
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Emergency medical services (EMS) personnel commonly use systolic blood pressure (sBP) to triage and treat acutely ill patients. The definition of prehospital hypotension and its associated outcomes are poorly defined. The authors sought to determine the discrimination of prehospital sBP thresholds for 30-day mortality and to compare patient classification by best-performing thresholds to traditional cutoffs. ⋯ Prehospital sBP is a modest discriminator of clinical outcomes, yet no threshold avoids substantial misclassification of 30-day mortality among noninjured patients.
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Randomized Controlled Trial Comparative Study
A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial.
The primary objective was to compare the efficacy of ultrasound (US)-guided three-in-one femoral nerve blocks to standard treatment with parenteral opioids for pain control in elderly patients with hip fractures in the emergency department (ED). ⋯ Ultrasound-guided femoral nerve block as an adjunct to SC resulted in 1) significantly reduced pain intensity over 4 hours, 2) decreased amount of rescue analgesia, and 3) no appreciable difference in adverse events when compared with SC alone. Furthermore, standard pain management with parenteral opioids alone provided ineffective pain control in our study cohort of patients with severe pain from their hip fractures. Regional anesthesia has a role in the ED, and US-guided femoral nerve blocks for pain management in older adults with hip fractures should routinely be considered, particularly in cases of refractory or severe pain.
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Randomized Controlled Trial
Dating violence: outcomes following a brief motivational interviewing intervention among at-risk adolescents in an urban emergency department.
A recent study demonstrated the efficacy of the SafERteens intervention in reducing peer violence among adolescents presenting to the emergency department (ED). The objective of this study was to determine the efficacy of this ED-based brief intervention (BI) on dating violence 1 year following the ED visit among the subsample of adolescents in the original randomized controlled trial reporting past-year dating violence. ⋯ ED-based BIs tailored to address multiple risk behaviors (i.e., peer violence, alcohol use, and dating violence) show promise for reducing moderate and severe dating victimization for up to 1 year following an ED visit.
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Comparative Study
Computer-facilitated review of electronic medical records reliably identifies emergency department interventions in older adults.
An estimated 14% to 25% of all scientific studies in peer-reviewed emergency medicine (EM) journals are medical records reviews. The majority of the chart reviews in these studies are performed manually, a process that is both time-consuming and error-prone. Computer-based text search engines have the potential to enhance chart reviews of electronic emergency department (ED) medical records. The authors compared the efficiency and accuracy of a computer-facilitated medical record review of ED clinical records of geriatric patients with a traditional manual review of the same data and describe the process by which this computer-facilitated review was completed. ⋯ A practical, non-resource-intensive, computer-facilitated free-text medical record review was completed and was more efficient and accurate than manually reviewing ED records.