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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Randomized Controlled Trial Comparative Study Clinical Trial
Ultrasonographic measurement of aortic diameter by emergency physicians approximates results obtained by computed tomography.
To assess agreement between emergency physicians' measurements of abdominal aortic diameter using ultrasound in the Emergency Department (ED) and measurements obtained by computed tomography (CT), a double-blinded, prospective study was conducted. The study enrolled a convenience sample of patients over 50 years of age presenting to the ED and scheduled to undergo CT scan of the abdomen and pelvis. Before CT scan, each patient received an ultrasound from a resident or attending emergency physician measuring anterior-posterior aortic diameter transversely at the approximate level of the superior mesenteric artery (SMA), longitudinally midway between the SMA and the iliac bifurcation, and transversely approximately 1 cm above the iliac bifurcation. ⋯ Agreement was closest on longitudinal view, with 95% of the differences expected to be less than 0.94 cm. Participating physicians estimated the time required to complete their ultrasound studies to be less than 5 min in a majority of cases. In conclusion, ultrasonographic measurement of aortic diameter by emergency physicians rapidly and effectively approximates measurements obtained by CT scan.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of nebulized magnesium sulfate plus albuterol to nebulized albuterol plus saline in children with acute exacerbations of mild to moderate asthma.
A prospective, randomized, double blinded study was conducted to determine whether a combination of nebulized magnesium sulfate and albuterol as a single dose adds any benefit in management of children with mild to moderate asthma when compared to nebulized albuterol with saline. The difference in FEV1 was significant at 10 and 20 min after a single dose of the combined treatment with magnesium and albuterol when compared with the albuterol and saline group (1.41 L +/- 0.53 vs. 1.13 L +/- 0.34, respectively, p = 0.03). The addition of magnesium to albuterol seems to provide short-term benefits in children with acute exacerbations of mild to moderate asthma.
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Randomized Controlled Trial Clinical Trial
Calcium chloride before i.v. diltiazem in the management of atrial fibrillation.
Diltiazem is commonly used to treat atrial fibrillation or flutter (AFF) with rapid ventricular response (RVR). Although it is very effective for rate control, up to an 18% prevalence of reported diltiazem-induced hypotension [defined by systolic blood pressure (SBP) < 90 mm Hg], and a mean of 9.7% hypotension have been reported from several studies totaling over 450 patients. This hypotension may complicate therapy. ⋯ CaCl(2) seems to be equally safe compared to placebo as a pre-treatment in the management of AFF with RVR, we were unable to find a statistically significant blunting of SBP drop with CaCl(2) i.v. pre-treatment. Until further research determines a benefit exists, we cannot recommend i.v. CaCl(2) pre-treatment before diltiazem in the treatment of AFF with RVR.