J Emerg Med
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Case Reports
Successful use of nasal BiPAP in three patients previously requiring intubation and mechanical ventilation.
Noninvasive mask ventilation may be used to treat patients with impending respiratory failure. In this case series, three patients with severe chronic obstructive pulmonary disease, who required mechanical ventilation in the past, were successfully treated with nasal bi-level positive airway pressure (BiPAP). All patients tolerated BiPAP well without complications. Therefore, nasal BiPAP may be considered a treatment option for patients with severe COPD who have previously required intubation and mechanical ventilation.
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Emergency department triage: a program assessment using the tools of continuous quality improvement.
An assessment was undertaken in the emergency department of a busy tertiary care center to illustrate the role of continuous quality improvement in the evaluation of an emergency triage program that utilizes the emergency medical attendant to provide triage. An evaluation team interviewed triage staff, charge nurses, internal customers, risk management, and the patient representative. A detailed review of staff job descriptions, organization charts, orientation manual, and physical facilities was conducted. ⋯ Direct observation was undertaken on nine occasions. An evaluation of the data gathered was performed using the tools of continuous quality improvement, and resulted in specific recommendations being made to improve the process of care. It was concluded that emergency medical attendants function very well in an emergency medicine triage system and the tools of continuous quality improvement can be applied to a clinical service to improve the quality of care.
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Randomized Controlled Trial Clinical Trial
The use of analgesics in patients with acute abdominal pain.
Analgesics in patients with acute abdominal pain are often withheld for fear that they may change physical examination findings and thus may be unsafe. We conducted a randomized, prospective, placebo-controlled trial to investigate changes in physical examination following the administration of placebo, 5 mg, or 10 mg of morphine to 49 patients with acute abdominal pain. ⋯ No adverse events or delays in diagnosis were attributed to the administration of analgesics. We conclude that physical examination does change after the administration of analgesics in patients with acute abdominal pain and that a larger study is needed to evaluate analgesic safety in this subpopulation of emergency department patients.
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Review Case Reports
Severe rhabdomyolysis with renal failure after intranasal cocaine use.
A case of acute renal failure due to rhabdomyolysis in a patient who used cocaine on a daily basis is presented. In contrast to many prior reports of renal failure occurring with cocaine-associated rhabdomyolysis, our patient did not use intravenous cocaine and did not have any evidence of trauma, seizure, hypotension, hyperthermia, hyperactivity, or coma. ⋯ He recovered fully after 3 weeks of dialysis. The literature is reviewed in an attempt to delineate a rational approach to evaluating cocaine users at risk for rhabdomyolysis.
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The purpose of this article is to provide a guide to assist the Emergency Physician in examining the eye. The evaluation of a patient with eye problems consists of a history, visual acuity, pupil examination, external examination, extra ocular movements, visual fields, and color vision. ⋯ After the slit lamp examination, the fundus and optic nerve is examined with a direct ophthalmoscope and intraocular pressure is measured. Special tests such as a plain film study and computed tomography (CT) scan may be obtained when indicated and, finally, referral to an ophthalmologist can be made for a dilated fundus examination, ultrasound studies of the eye and orbit, and surgical treatment.