Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Editorial Biography Historical Article
Michelle H. Biros, MD, MS, completes 10 years as editor-in-chief of Academic Emergency Medicine.
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Randomized Controlled Trial Comparative Study
Oral versus intravenous opioid dosing for the initial treatment of acute musculoskeletal pain in the emergency department.
The objective was to compare the time to medication administration, the side effects, and the analgesic effect at sequential time points after medication administration of an oral treatment strategy using oxycodone solution with an intravenous (IV) treatment strategy using morphine sulfate for the initial treatment of musculoskeletal pain in emergency department (ED) patients. ⋯ The oral loading strategy was associated with delayed onset of analgesia and decreased patient satisfaction, but a shorter time to administration. The oral loading strategy using an oxycodone solution provided similar pain relief to the IV strategy using morphine 30 minutes after administration of the drug. Oral 0.125 mg/kg oxycodone represents a feasible alternative to 0.1 mg/kg IV morphine in the treatment of severe acute musculoskeletal pain when difficult or delayed IV placement greater than 30 minutes presents a barrier to treatment.
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Comparative Study
Emergency department crowding and decreased quality of pain care.
The objective of this study was to evaluate the association of emergency department (ED) crowding factors with the quality of pain care. ⋯ ED crowding as measured by patient volume negatively impacts patient care. Greater numbers of patients in the ED, whether as total census or number of boarders, were associated with worse pain care.
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Comparative Study
International survey of emergency physicians' awareness and use of the Canadian Cervical-Spine Rule and the Canadian Computed Tomography Head Rule.
The derivation and validation studies for the Canadian Cervical-Spine (C-Spine) Rule (CCR) and the Canadian Computed Tomography (CT) Head Rule (CCHR) have been published in major medical journals. The objectives were to determine: 1) physician awareness and use of these rules in Australasia, Canada, the United Kingdom, and the United States and 2) physician characteristics associated with awareness and use. ⋯ This large international study found notable differences among countries with regard to knowledge and use of the CCR and CCHR. Awareness and use of both rules were highest in Canada and lowest in the United States. While younger physicians, those employed full-time, and those working in teaching hospitals were more likely to be aware of a decision rule, age and employment status were not significant predictors of use. A better understanding of factors related to awareness and use of emergency medicine (EM) decision rules will enhance our understanding of knowledge translation and facilitate strategies to enhance dissemination and implementation of future rules.