J Emerg Med
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Randomized Controlled Trial Comparative Study
Bullard laryngoscopy by naïve operators in the cervical spine immobilized patient.
To determine ease of Bullard laryngoscopy by naïve operators during cervical spine immobilization, 21 residents, naïve to the Bullard laryngoscope, were assigned to perform Bullard laryngoscopy and standard direct laryngoscopy on the Laerdal SimMan Universal Patient Simulator while the rigid cervical spine function was engaged. Sequences were repeated. ⋯ Similarly, ease of use was statistically unchanged over time for Macintosh laryngoscopy, but there was statistically significant improvement in ease of use for the Bullard. The Bullard laryngoscope is an easily mastered airway management device for intubation of the cervical spine immobilized patient.
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Randomized Controlled Trial Multicenter Study Comparative Study
Observation unit treatment of heart failure with nesiritide: results from the proaction trial.
This was a multicenter, randomized, double-blind, placebo-controlled pilot study, evaluating the safety and efficacy of a standard care treatment regimen with the addition of either nesiritide or placebo (SCP) in 237 Emergency Department (ED)/Observation Unit (OU) patients with decompensated heart failure (HF). Efficacy measures included initial admission, length of hospital stay (LOS), and inpatient rehospitalization through 30 days. ⋯ The incidence of symptomatic hypotension was low and did not differ between the groups. This study showed that nesiritide is safe when used in the emergency department, observation units, or similar settings.
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Heart failure is a disease of epidemic proportions. Almost five million Americans suffer from heart failure and over 400,000 patients are newly diagnosed with heart failure each year. Indeed, heart failure is now the only cardiovascular disease that is increasing in incidence and prevalence. ⋯ Recently, the outcomes of several high-profile clinical trials evaluating intravenous nesiritide (human B-type natriuretic peptide) have suggested a benefit in select hospitalized patients. Such a therapy has potential to provide a therapeutic addition or alternative for emergency heart failure management. We discuss these trials' results, suggest their relationship to the ED population, and provide recommendations for appropriate ED use.
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Bupropion overdose mainly is characterized by tachycardia, agitation, and seizures. The few reports of QRS complex widening after bupropion overdose that have been published in peer-reviewed literature are notable for failure to have confirmed elevated plasma bupropion concentrations or failure to have excluded other causes of QRS widening. ⋯ Our findings are in keeping with ex vivo studies in which bupropion antagonizes cardiac voltage-gated sodium channels. Bupropion overdose should be considered in the differential diagnosis of unexpected QRS widening.