J Emerg Med
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Peripheral venous blood gas (pVBG) analysis in replacement of arterial blood gas (ABG) is limited by the unpredictable differences between arterial and venous values, especially for PCO2 and pH (ΔPCO2 and ΔpH). ⋯ The variability of ΔPCO2 and ΔpH is significantly lowered when the venous values are corrected according to the SpvO2 value, and pVBG is therefore more accurate and valid for detecting an arterial abnormality.
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Volvulus of the sigmoid colon is a potentially life-threatening condition rarely seen in younger age groups and is male predominant. ⋯ Sigmoid volvulus is rarely seen in developed countries. Clinical manifestations vary with disease progression, but it typically presents with a triad of constipation, progressive abdominal distension, and severe abdominal pain. Plain-film x-ray studies can demonstrate a coffee bean or "omega loop" (inverted-U sigmoid) sign in <60% cases, but it was reported as high as 86% in computed tomography. The whirl sign on computed tomography might also be observed. The cause is multifactorial and colonic length is the most important predisposing factor. Flexible colon fiberscopic decompression followed by elective definitive surgery is the treatment choice, but exploratory laparotomy is mandatory if any complicated entity occurs. The mortality rate is still >50% when bowel gangrene develops.
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Pericardiocentesis is a rare but potentially life-saving procedure. Improper technique can lead to life-threatening complications. ⋯ This cadaveric model allows trainees to familiarize themselves with both proper landmark and ultrasound-based pericardiocentesis technique.
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Multicenter Study Comparative Study
Single-operator ultrasound-guided intravenous line placement by emergency nurses reduces the need for physician intervention in patients with difficult-to-establish intravenous access.
Emergency physicians (EPs) have become facile with ultrasound-guided intravenous line (USIV) placement in patients for whom access is difficult to achieve, though the procedure can distract the EP from other patient care activities. ⋯ ENs performing single-operator USIV placement in patients with difficult-to-establish i.v. access reduces the need for EP intervention.
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Randomized Controlled Trial
Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study.
Acute alcohol withdrawal syndrome (AAWS) is encountered in patients presenting acutely to the Emergency Department (ED) and often requires pharmacologic management. ⋯ A single dose of i.v. phenobarbital combined with a symptom-guided lorazepam-based alcohol withdrawal protocol resulted in decreased ICU admission and did not cause increased adverse outcomes.