Can J Emerg Med
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Randomized Controlled Trial
Are patients willing to remove, and capable of removing, their own nonabsorbable sutures?
Providing patients with instructions and equipment regarding self-removal of nonabsorbable sutures could represent a new efficiency in emergency department (ED) practice. The primary outcome was to compare the proportion of patients successfully removing their own sutures when provided with suture removal instructions and equipment versus the standard advice and follow-up care. Secondary outcomes included complication rates, number of physician visits, and patient comfort level. ⋯ Most patients are willing to remove, and capable of removing, their own sutures. Providing appropriate suture removal instructions and equipment to patients with simple lacerations in the ED appears to be both safe and acceptable.
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Randomized Controlled Trial Multicenter Study Comparative Study
Dopamine versus norepinephrine in the treatment of shock.
Which vasopressor agent, norepinephrine or dopamine, is superior in the treatment of shock? ⋯ The authors of this study set out to compare 28-day mortality in patients with shock who were treated with either dopamine or norepinephrine as initial vasopressor therapy. The authors' secondary outcome measures included mortality beyond 28 days and adverse events associated with each agent.
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Randomized Controlled Trial Multicenter Study Comparative Study
Intra-articular lidocaine versus intravenous sedation for the reduction of anterior shoulder dislocations in the emergency department.
The objective was to compare intra-articular lidocaine (IAL) versus intravenous sedation (IVS) for the reduction of acute, anterior shoulder dislocations in the emergency department (ED) in terms of ED length of stay, rate of successful reductions, patient satisfaction, and complications. ⋯ There was no difference in ED length of stay between groups. There was a lower rate of successful reductions and lower satisfaction scores in the IAL group.
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Randomized Controlled Trial Multicenter Study
Effect of inhaled hypertonic saline on hospital admission rate in children with viral bronchiolitis: a randomized trial.
We sought to determine whether inhaled 3% hypertonic saline (HS) reduces admission to hospital in ambulatory children with moderately severe viral bronchiolitis. Secondary objectives compared changes in respiratory scores before and after treatment and assessed the need for unscheduled medical intervention within 7 days. ⋯ The short-term use of nebulized 3% HS did not result in any statistically significant benefits, although a nonsignificant trend toward a decrease in admission rate and improvement in respiratory distress was found. A larger study would be required to determine whether these trends arise from a clinically relevant treatment effect.
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Randomized Controlled Trial Comparative Study
A comparative evaluation of capnometry versus pulse oximetry during procedural sedation and analgesia on room air.
Important questions remain regarding how best to monitor patients during procedural sedation and analgesia (PSA). Capnometry can detect hypoventilation and apnea, yet it is rarely used in emergency patients. Even the routine practice of performing preoxygenation in low-risk patients is controversial, as supplementary oxygen can delay the detection of respiratory depression by pulse oximetry. The purpose of this study was to determine whether the capnometer or the pulse oximeter would first detect respiratory events in adults breathing room air. ⋯ During PSA in adults breathing room air, desaturation detectable by pulse oximeter usually occurs before overt changes in capnometry are identified.