Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized, double-blind, comparative study of the efficacy of ketorolac tromethamine versus meperidine in the treatment of severe migraine.
To evaluate the relative efficacy of ketorolac tromethamine and meperidine hydrochloride in the emergency department treatment of severe migraine. ⋯ IM ketorolac tromethamine is less effective than meperidine in the ED treatment of severe migraine.
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To evaluate the impact of an emergency medicine residency training program on the cost of care in the emergency department. ⋯ As measured by selected test use for six common discharge diagnoses, the introduction of an emergency medicine residency program did not increase the cost of care in this urban community hospital ED.
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Pediatric endotracheal (ET) tubes can be accurately selected based on body length using a specialized emergency tape. ⋯ A system for length-based selection of emergency equipment represents a significant adjunct to emergency physicians and paramedics who must deal with critically ill children. Length-based ET tube selection is clearly superior to age-based rules, which are difficult to remember and require accurate estimation of a patient's age.
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Review
Use of tetracaine, epinephrine, and cocaine as a topical anesthetic in the emergency department.
The combination of tetracaine, epinephrine, and cocaine has gained wide acceptance as a topical anesthetic agent for use on pediatric dermal lacerations in the ED. This is despite the fact that the optimal dose and formulation have yet to be determined. TAC can be applied painlessly to wounds and is about as effective as lidocaine infiltration for anesthetizing pediatric facial and scalp lacerations. ⋯ Close medical monitoring of the patient is essential to detect signs of toxicity. Research on other topical agents such as tetracaine with epinephrine is also needed. Although anesthetizing wounds painlessly remains a worthy goal, exposing patients to added and unknown risks and increasing the cost of health care is unacceptable.