Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial
Assessment of Common Preoxygenation Strategies Outside of the Operating Room Environment.
Preoxygenation prior to intubation aims to increase the duration of safe apnea by causing denitrogenation of the functional residual capacity, replacing this volume with a reservoir of oxygen. In the operating room (OR) the criterion standard for preoxygenation is an anesthetic circuit and well-fitting face mask, which provide a high fractional inspired oxygen concentration (FiO2 ). Outside of the OR, various strategies exist to provide preoxygenation. The objective was to evaluate the effectiveness of commonly used preoxygenation strategies outside of the OR environment. ⋯ In healthy volunteers, the effectiveness of BVM preoxygenation was comparable to the anesthetic circuit (criterion standard) and superior to preoxygenation with NRM. The addition of NC oxygen, PEEP, or both did not improve the efficacy of the BVM device.
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Observational Study
Patient-Reported Outcomes from A National, Prospective, Observational Study of Emergency Department Acute Pain Management with an Intranasal NSAID, Opioids or Both.
Patient compliance and satisfaction with analgesics prescribed after emergency department (ED) care for acute pain are poorly understood, largely because of the lack of direct patient follow-up with the ED provider. Our objective was to compare patient satisfaction with three analgesia regimens prescribed for post-ED care-a nasally administered nonsteroidal anti-inflammatory drug (NSAID), an opioid, or combination therapy-by collecting granular follow-up on analgesic use, pain scores, side effects, work activity levels, and overall satisfaction directly from patients. ⋯ Automated telephonic follow-up of ED patients prescribed short-term analgesia is feasible. Ketorolac-based analgesia after an ED visit for many acute pain syndromes was associated with favorable patient outcomes and higher satisfaction than opioid-based therapy. SPRIX, an NSAID that is not available over the counter and has a novel delivery approach, may be useful for short-term post-ED outpatient analgesia.
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Observational Study
Muscle oxygen saturation improves diagnostic association between initial vital signs and major hemorrhage: a prospective observational study.
During initial assessment of trauma patients, vital signs do not identify all patients with life-threatening hemorrhage. We hypothesized that a novel vital sign, muscle oxygen saturation (SmO2 ), could provide independent diagnostic information beyond routine vital signs for identification of hemorrhaging patients who require packed red blood cell (RBC) transfusion. ⋯ SmO2 significantly improved the diagnostic association between initial vital signs and hemorrhagic injury with blood transfusion. This parameter may enhance the early identification of patients who require blood products for life-threatening hemorrhage.
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Alternative-level metrics (Altmetrics) are a new method to assess the sharing and spread of scientific knowledge. The primary objective of this study was to describe the traditional metrics and Altmetric scores of the 50 most frequently cited articles published in emergency medicine (EM) journals. Since many articles related to EM are published in other journals, the secondary aim of this study was to describe the Altmetric scores of the most frequently cited articles relevant to EM in other biomedical journals. ⋯ This study is the first analysis of Altmetric scores for the top cited articles in EM. We demonstrated that there is a mild correlation between citation counts and Altmetric scores for the top papers in EM and other biomedical journals. We also demonstrated that there is a gap between the sharing of the top articles in EM journals and those related to EM in other biomedical journals. Future research to explore this relationship and its temporal trends will benefit the understanding of the reach and dissemination of EM research within the scientific community and society in general.
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Review Meta Analysis
Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis.
Acute heart failure (AHF) is one of the most common diagnoses assigned to emergency department (ED) patients who are hospitalized. Despite its high prevalence in the emergency setting, the diagnosis of AHF in ED patients with undifferentiated dyspnea can be challenging. ⋯ Bedside lung US and echocardiography appear to the most useful tests for affirming the presence of AHF while NPs are valuable in excluding the diagnosis.