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EMCurious Practice Changing Research

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40 papers 25 to 100 followers
James Quinn, Daniel McDermott
OBJECTIVES: To determine the sensitivity and specificity of the San Francisco Syncope Rule (SFSR) electrocardiogram (ECG) criteria for determining cardiac outcomes and to define the specific ECG findings that are the most important in patients with syncope. METHODS: A consecutive cohort of emergency department (ED) patients with syncope or near syncope was considered. The treating emergency physicians assessed 50 predictor variables, including an ECG and rhythm assessment...
July 2011: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
David Swenson, Matt Flannigan, J S Jones
A shortcut review was carried out to establish whether intraoral ultrasound increased the accuracy of diagnosis and the success of aspiration in adults with suspected peritonsillar abscess (quinsy). Using the reported searches, one paper presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. It is concluded that emergency physician-performed intraoral ultrasound can reliably diagnose peritonsillar abscess and leads to greater success at aspiration when compared with the traditional landmark technique...
December 2014: Emergency Medicine Journal: EMJ
Anne-Maree Kelly
Blood gas analysis is an integral part of the assessment of emergency department (ED) patients with acute respiratory or metabolic disease. Traditionally ABG analyses have been used, but increasingly, emergency clinicians are using venous blood gas (VBG) analyses. This has been challenged, especially by respiratory physicians, as being too inaccurate. This clinical review, using case examples, summarises the evidence supporting use of VBG to guide management decisions. Arteriovenous agreement for pH is such that values are clinically interchangeable and agreement for bicarbonate is also close...
February 2016: Emergency Medicine Journal: EMJ
Y Passi, M Sathyamoorthy, J Lerman, C Heard, M Marino
BACKGROUND: Miller laryngoscope blades are preferred for laryngoscopy in infants and children <2 yr of age. Despite their long history, the laryngeal view with the Miller blade size 1 has never been compared with that with the Macintosh (MAC) blade in children. This prospective, single-blinded, randomized study was designed to compare the laryngeal views with the size 1 Miller and MAC blades in children <2 yr. METHODS: With IRB approval, 50 ASA I and II children <2 yr undergoing elective surgery were enrolled...
November 2014: British Journal of Anaesthesia
Na Rae Ju, Alex Koyfman
No abstract text is available yet for this article.
January 2015: Annals of Emergency Medicine
John Scotter, Susan Hendrickson, Hani J Marcus, Mark H Wilson
PRIMARY OBJECTIVE: To review the prognosis of patients with bilateral fixed and dilated pupils secondary to traumatic extradural (epidural) or subdural haematoma who undergo surgery. METHODS: A systematic review and meta-analysis was performed using random effects models. The Cochrane Central Register of Controlled Trials and PubMed databases were searched to identify relevant publications. Eligible studies were publications that featured patients with bilateral fixed and dilated pupils who underwent surgical evacuation of traumatic extra-axial haematoma, and reported on the rate of favourable outcome (Glasgow Outcome Score 4 or 5)...
August 2015: Emergency Medicine Journal: EMJ
Elizabeth Rubano, Ninfa Mehta, William Caputo, Lorenzo Paladino, Richard Sinert
BACKGROUND: The use of ultrasound (US) to diagnose an abdominal aortic aneurysm (AAA) has been well studied in the radiology literature, but has yet to be rigorously reviewed in the emergency medicine arena. OBJECTIVES: This was a systematic review of the literature for the operating characteristics of emergency department (ED) ultrasonography for AAA. METHODS: The authors searched PubMed and EMBASE databases for trials from 1965 through November 2011 using a search strategy derived from the following PICO formulation: Patients-patients (18+ years) suspected of AAA...
February 2013: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Sean Collins, Alan B Storrow, Nancy M Albert, Javed Butler, Justin Ezekowitz, G Michael Felker, Gregory J Fermann, Gregg C Fonarow, Michael M Givertz, Brian Hiestand, Judd E Hollander, David E Lanfear, Phillip D Levy, Peter S Pang, W Frank Peacock, Douglas B Sawyer, John R Teerlink, Daniel J Lenihan
Heart failure (HF) afflicts nearly 6 million Americans, resulting in one million emergency department (ED) visits and over one million annual hospital discharges. An aging population and improved survival from cardiovascular diseases is expected to further increase HF prevalence. Emergency providers play a significant role in the management of patients with acute heart failure (AHF). It is crucial that emergency physicians and other providers involved in early management understand the latest developments in diagnostic testing, therapeutics and alternatives to hospitalization...
January 2015: Journal of Cardiac Failure
Sripal Bangalore, Harikrishna Makani, Martha Radford, Kamia Thakur, Bora Toklu, Stuart D Katz, James J DiNicolantonio, P J Devereaux, Karen P Alexander, Jorn Wetterslev, Franz H Messerli
BACKGROUND: Debate exists about the efficacy of β-blockers in myocardial infarction and their required duration of usage in contemporary practice. METHODS: We conducted a MEDLINE/EMBASE/CENTRAL search for randomized trials evaluating β-blockers in myocardial infarction enrolling at least 100 patients. The primary outcome was all-cause mortality. Analysis was performed stratifying trials into reperfusion-era (> 50% undergoing reperfusion or receiving aspirin/statin) or pre-reperfusion-era trials...
October 2014: American Journal of Medicine
Francesca L Beaudoin, Charlie Lin, Wentao Guan, Roland C Merchant
OBJECTIVES: Low-dose ketamine has been used perioperatively for pain control and may be a useful adjunct to intravenous (IV) opioids in the control of acute pain in the emergency department (ED). The aim of this study was to determine the effectiveness of low-dose ketamine as an adjunct to morphine versus standard care with morphine alone for the treatment of acute moderate to severe pain among ED patients. METHODS: A double-blind, randomized, placebo-controlled trial with three study groups was conducted at a large, urban academic ED over a 10-month period...
November 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Robert M Rodriguez, Deirdre Anglin, Mark I Langdorf, Brigitte M Baumann, Gregory W Hendey, Richard N Bradley, Anthony J Medak, Ali S Raja, Paul Juhn, Jonathan Fortman, William Mulkerin, William R Mower
IMPORTANCE: Chest radiography (chest x-ray [CXR] and chest computed tomography [CT]) is the most common imaging in blunt trauma evaluation. Unnecessary trauma imaging leads to greater costs, emergency department time, and patient exposure to ionizing radiation. OBJECTIVE To validate our previously derived decision instrument (NEXUS Chest) for identification of blunt trauma patients with very low risk of thoracic injury seen on chest imaging (TICI). We hypothesized that NEXUS Chest would have high sensitivity (>98%) for the prediction of TICI and TICI with major clinical significance...
October 2013: JAMA Surgery
Alberto Palazzuoli, Marco Pellegrini, Gaetano Ruocco, Giuseppe Martini, Beatrice Franci, Maria Stella Campagna, Marilyn Gilleman, Ranuccio Nuti, Peter A McCullough, Claudio Ronco
INTRODUCTION: Intravenous loop diuretics are a cornerstone of therapy in acutely decompensated heart failure (ADHF). We sought to determine if there are any differences in clinical outcomes between intravenous bolus and continuous infusion of loop diuretics. METHODS: Subjects with ADHF within 12 hours of hospital admission were randomly assigned to continuous infusion or twice daily bolus therapy with furosemide. There were three co-primary endpoints assessed from admission to discharge: the mean paired changes in serum creatinine, estimated glomerular filtration rate (eGFR), and reduction in B-type natriuretic peptide (BNP)...
June 28, 2014: Critical Care: the Official Journal of the Critical Care Forum
Michael E Vrablik, Gregory R Snead, Hal J Minnigan, Jonathan M Kirschner, Thomas W Emmett, Rawle A Seupaul
The diagnostic accuracy of emergency department (ED) ocular ultrasonography may be sufficient for diagnosing retinal detachment. We systematically reviewed the literature to determine the diagnostic accuracy of ED ocular ultrasonography for the diagnosis of retinal detachment. This review conformed to the recommendations from the Meta-analysis of Observational Studies in Epidemiology statement. An experienced medical librarian searched the following databases from their inception, without language restrictions: Ovid MEDLINE, PubMed, EMBASE, the Cochrane Library, Emergency Medical Abstracts, and Google Scholar...
February 2015: Annals of Emergency Medicine
Jiang He, Yonghong Zhang, Tan Xu, Qi Zhao, Dali Wang, Chung-Shiuan Chen, Weijun Tong, Changjie Liu, Tian Xu, Zhong Ju, Yanbo Peng, Hao Peng, Qunwei Li, Deqin Geng, Jintao Zhang, Dong Li, Fengshan Zhang, Libing Guo, Yingxian Sun, Xuemei Wang, Yong Cui, Yongqiu Li, Dihui Ma, Guang Yang, Yanjun Gao, Xiaodong Yuan, Lydia A Bazzano, Jing Chen
IMPORTANCE: Although the benefit of reducing blood pressure for primary and secondary prevention of stroke has been established, the effect of antihypertensive treatment in patients with acute ischemic stroke is uncertain. OBJECTIVE: To evaluate whether immediate blood pressure reduction in patients with acute ischemic stroke would reduce death and major disability at 14 days or hospital discharge. DESIGN, SETTING, AND PARTICIPANTS: The China Antihypertensive Trial in Acute Ischemic Stroke, a single-blind, blinded end-points randomized clinical trial, conducted among 4071 patients with nonthrombolysed ischemic stroke within 48 hours of onset and elevated systolic blood pressure...
February 5, 2014: JAMA: the Journal of the American Medical Association
Theresa Anne Rowe, Manisha Juthani-Mehta
Urinary tract infection (UTI) is a commonly diagnosed infection in older adults. Despite consensus guidelines developed to assist providers in diagnosing UTI, distinguishing symptomatic UTI from asymptomatic bacteriuria (ASB) in older adults is problematic, as many older adults do not present with localized genitourinary symptoms. This article summarizes the recent literature and guidelines on the diagnosis and management of UTI and ASB in older adults.
March 2014: Infectious Disease Clinics of North America
Phillips Perera, Thomas Mailhot, David Riley, Diku Mandavia
The RUSH exam (Rapid Ultrasound in SHock examination), presented in this article, represents a comprehensive algorithm for the integration of bedside ultrasound into the care of the patient in shock. By focusing on a stepwise evaluation of the shock patient defined here as "Pump, Tank, and Pipes," clinicians will gain crucial anatomic and physiologic data to better care for these patients.
February 2010: Emergency Medicine Clinics of North America
Mohammad Al Deeb, Skye Barbic, Robin Featherstone, Jerrald Dankoff, David Barbic
OBJECTIVES: Acute dyspnea is a common presenting complaint to the emergency department (ED), and point-of-care (POC) lung ultrasound (US) has shown promise as a diagnostic tool in this setting. The primary objective of this systematic review was to determine the sensitivity and specificity of US using B-lines in diagnosing acute cardiogenic pulmonary edema (ACPE) in patients presenting to the ED with acute dyspnea. METHODS: A systematic review protocol adhering to Cochrane Handbook guidelines was created to guide the search and analysis, and we searched the following databases: PubMed, EMBASE, Ovid MEDLINE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, and the Cochrane Database of Systematic Reviews...
August 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Pradyumna Raval, Wasim Khan, Behrooz Haddad, Anant Narayan Mahapatra
Patients presenting to the emergency department with bite injuries to the hand sustain them through a number of causes including domesticated as well as stray animal bites, and human bites commonly sustained as a result of violence. The nature of the injuries sustained can be very deceptive. A small tooth mark on the exterior can be a fulminant infection in the tissues deeper down. Tendon injuries, fractures of the metacarpals and phalanges and management of the wound are critical issues faced by a surgeon in dealing with such patients...
2014: Open Orthopaedics Journal
Julie Gorchynski, Eddie Karabidian, Michael Sanchez
BACKGROUND: The traditional intraoral manual reduction of temporomandibular joint (TMJ) dislocations is time consuming, difficult, and at times ineffective, and commonly requires conscious sedation. OBJECTIVES: We describe a novel technique for the reduction of acute nontraumatic TMJ dislocations in the emergency department (ED). METHODS: This study was a prospective convenience sample population during a 3-year period at two university teaching-hospital EDs where acute nontraumatic TMJ dislocations were reduced utilizing our syringe technique...
December 2014: Journal of Emergency Medicine
James D Campagna, Michael C Bond, Esteban Schabelman, Bryan D Hayes
BACKGROUND: The practice of avoiding cephalosporin administration to penicillin-allergic patients persists despite the low rate of cross reactions between both groups of antibiotics. OBJECTIVE: The purpose of this literature review is to evaluate the published evidence regarding the commonly held belief that patients with a history of an allergic reaction to penicillin have a significantly increased risk of an allergic reaction to cephalosporins. MATERIALS AND METHODS: Articles were identified through a computerized search of MEDLINE from 1950 to the present using the search terms "penicillin$," "cephalosporin$," "allerg$," "hypersensitivity," and "cross-react$...
May 2012: Journal of Emergency Medicine
2014-11-03 02:17:23
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