J Emerg Med
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Randomized Controlled Trial Multicenter Study
Bedside ultrasound for the detection of soft tissue foreign bodies: a cadaveric study.
The objective of this study was to evaluate the sensitivity and specificity of bedside ultrasound, as performed by emergency physicians with typical equipment, in detecting small, soft tissue foreign bodies, using a cadaveric model. This was a prospective study, using 6 unembalmed human cadavers and 6 ultrasound-credentialed, emergency medicine residency-trained physicians as sonographers. Incisions were made in 150 total sites of the extremities and each site was randomly assigned one of five groups: wood, metal, plastic, glass, or no foreign body. ⋯ Sensitivity for individual sonographers ranged from 40.8% to 72.3% (average 52.6% +/- 13.3%), and specificity ranged from 30% to 66.7% (average 47.2% +/- 15.1%). Inter-observer reliability was poor. In our model, bedside ultrasound performed by emergency physicians was neither sensitive nor specific for the presence of small soft tissue foreign bodies.
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Randomized Controlled Trial
Clinical efficacy of dexamethasone for acute exudative pharyngitis.
The objective of this study was to investigate whether treatment with single-dose dexamethasone can provide relief of symptoms in acute exudative pharyngitis. A prospective, randomized, double-blinded, placebo-controlled clinical trial was undertaken over a 3-month period in a university-based Emergency Department. The study included all consecutive patients between 18 and 65 years of age presenting with acute exudative pharyngitis, sore throat, odynophagia, or a combination, and with more than two Centor criteria. ⋯ No significant difference was observed in vital signs between the regimens. No side effects and no new complaints attributable to the dexamethasone and azithromycin were observed. Sore throat and odynophagia in patients with acute exudative pharyngitis may respond better to treatment with an 8-mg single dose of intramuscular dexamethasone accompanied by an antibiotic regimen than to antibiotics alone.
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Randomized Controlled Trial Comparative Study
A randomized controlled trial comparing one-operator versus two-operator technique in ultrasound-guided basilic vein cannulation.
The basilic vein offers an alternative site for peripheral intravenous access for emergency access. The use of a two-operator ultrasound-guided basilic vein cannulation technique has been shown to be a safe and effective technique for use on Emergency Department patients. However, the one-operator technique is more customary by other services. ⋯ There were no complications with either technique (95% CI 0-10%). Novice operators can reliably perform a basilic vein cannulation using ultrasound guidance. However, we were unable to demonstrate any advantage for any particular technique in cannulating the basilic vein.
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Randomized Controlled Trial Comparative Study
Prochlorperazine vs. promethazine for headache treatment in the emergency department: a randomized controlled trial.
Headache is a very common medical complaint. Four to six percent of the population will have a debilitating headache in their lifetime; and 1-2% of all Emergency Department (ED) visits involve patients with headaches. Although promethazine is used frequently, it has never been studied as a single-agent treatment in undifferentiated headache. ⋯ Prochlorperazine provided a faster rate of pain resolution and less drowsiness when compared to promethazine. Both medications were individually effective as abortive therapy for headache. Prochlorperazine was superior to promethazine in the rate of headache reduction and rate of home drowsiness, with similar rates of akathesia, nausea resolution, patient satisfaction, and headache recurrence within 5 days of discharge.
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Randomized Controlled Trial Multicenter Study
EMDOC (Emergency Department overcrowding) Internet-based safety net research.
Emergency Department (ED) overcrowding is a national crisis with few prospective data to document its occurrence. The objective of this study was to prospectively collect data on variables involved in Emergency Department overcrowding (EMDOC) using an Internet-based data entry model. A prospective observational Internet-based study involving 18 hospitals over a 13-month period was designed. ⋯ The mean number of makeshift beds was 3.1. There was no single variable that was noted to define or predict overcrowding. Documentation of factors involved in ED overcrowding found that overcrowding was not just an ED problem, but a problem that occurs due to overcrowding in the entire institution.