Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial Comparative Study
Randomized clinical trial of nebulized fentanyl citrate versus i.v. fentanyl citrate in children presenting to the emergency department with acute pain.
To compare the pain relief achieved with nebulized fentanyl citrate with intravenous (i.v.) fentanyl citrate in children presenting to the emergency department (ED) with painful conditions to determine if nebulized fentanyl is a feasible alternative to i.v. fentanyl for the treatment of acute pain in children. ⋯ Nebulized fentanyl citrate 3 microg/kg through a breath-actuated nebulizer appears to be a feasible alternative to i.v. fentanyl citrate for a variety of painful conditions in patients older than 3 years.
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Comparative Study
Reliability of a computerized version of the Pediatric Canadian Triage and Acuity Scale.
The use of a standardized triage tool allows better comparison of the patients; a computerized version could theoretically improve its reliability. ⋯ A computerized version of the PedCTAS showed a statistically significant improvement in the interrater agreement for nurses evaluating the triage level of 54 clinical scenarios, but this difference has probably small clinical significance.
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Comparative Study
Evaluating the effectiveness of dispatch-assisted cardiopulmonary resuscitation instructions.
To determine the frequency of agonal breathing during cardiac arrest (CA), its impact on the ability of 9-1-1 dispatchers to identify CA, and the impact of dispatch-assisted cardiopulmonary resuscitation (CPR) instructions on bystander CPR rates. ⋯ This trial demonstrates an increase in bystander CPR rate after the introduction of dispatch-assisted CPR. Agonal breathing occurred frequently and had a negative impact on the recognition of CA. There were long time intervals between call initiation and diagnosis of CA and during mouth-to-mouth ventilation instructions.
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Randomized Controlled Trial
Caregiver and health care provider satisfaction with volumetric bladder ultrasound.
Conventional (nonimaged) bladder catheterization has lower first-attempt success rates (67%-72%) when compared with catheterization aided by volumetric bladder ultrasonography (US) (92%-100%), yet the total time to urine sample collection with US can be quite lengthy. Given the advantage and disadvantages, the authors assessed caregiver and health care provider satisfaction with these two methods. ⋯ Caregivers in the conventional group rated their children's discomfort higher than did caregivers in the US group. Both caregivers and health care providers expressed greater satisfaction with US and were more likely to prefer this imaging modality with future catheterization attempts.
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To measure the quality of emergency department (ED) care for patients with acute myocardial infarction (AMI) and pneumonia (PNA) and to estimate the number of preventable deaths in these patients. ⋯ Quality of care in the ED management of AMI and PNA is below national goals. This deficiency accounts for significant preventable deaths.