Annals of emergency medicine
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Randomized Controlled Trial Clinical Trial
The emergency department treatment of dyspepsia with antacids and oral lidocaine.
The treatment of dyspepsia in the emergency department often consists of antacid in combination with viscous lidocaine, even though the specific etiology of the pain is frequently unknown. The efficacy of lidocaine as a component of symptomatic therapy was evaluated in a randomized, patient-blinded protocol. Patients presenting to the ED with dyspeptic symptoms were randomized to receive 30 mL of antacid (Mylanta II), or 30 mL of antacid plus 15 mL of 2% viscous lidocaine (GI cocktail). ⋯ Assessment of pain relief using a five-point rating scale also indicated greater relief with GI cocktail therapy compared with antacid alone (P = .004). No adverse effects were noted with either treatment. We conclude that a single dose of antacid and viscous lidocaine provides a significantly greater degree of immediate pain relief than antacid alone in patients with dyspepsia.
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Although we commonly assume that because residents spend a given number of months in the emergency department they achieve adequate exposure to all necessary clinical entities, this has never been shown. We suspect, rather, that great variability exists among residents in the number and variety of patients they see; and that with respect to the ED, there are important diagnoses that are rare or absent in the clinical pathology of a training program. To confirm these hypotheses, we implemented a computerized system of recording patients and diagnoses managed in the ED by the 33 residents of the University of Illinois Affiliated Hospitals Emergency Medicine Residency. ⋯ In this study, residents fell short of these guidelines with 50.5% of diagnoses. While absolute quantity of exposure does not assure competence in management, we recommend that each residency monitor the experience of its residents. This allows a residency to change its curriculum to make optimum use of available pathology, as well as to supplement deficiencies in clinical experience with case simulations.