Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Pain reduction in local anesthetic administration through pH buffering.
The effects of pH buffering on the pain of administration and efficacy of three local anesthetics (1% lidocaine, 1% lidocaine with 1:100,000 epinephrine, and 1% mepivacaine) were investigated in a randomized, prospective, double-blind study of 25 adult volunteers. Plain and buffered solutions of the three local anesthetics were prepared, and a 0.5 intradermal injection of each was administered. Pain of anesthetic infiltration was rated from zero to ten. ⋯ Onset, extent, and duration of skin anesthesia were not statistically altered by pH buffering. The pain of local anesthetic administration can be dramatically reduced by buffering the local anesthetic prior to its infiltration. Anesthetic efficacy is not compromised, and patient acceptance may be significantly increased.
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Echocardiography is the "gold standard" for diagnosing many cardiac and pericardial abnormalities. It is noninvasive and accurate, but in most emergency departments is only as available as the technician or the cardiologist. We describe our experience in training emergency physicians to perform cardiac ultrasound, and clinical situations in which we have found echocardiography to be useful.