Annals of emergency medicine
-
Randomized Controlled Trial Clinical Trial
A randomized, controlled trial of radiograph ordering for extremity trauma in a pediatric emergency department.
The objectives of this study were to determine whether triage nurses using the Brand protocol would order fewer radiographs than would physicians carrying out standard practice procedures, without missing an increased number of joint or bone injuries; the test characteristics and the interobserver reliability of the Brand protocol; and whether having triage nurses order radiographs could reduce total patient waiting time in the emergency department. ⋯ Having triage nurses use the Brand protocol reduced the number of radiographs ordered but at the same time increased the number of missed radiographic findings. However, having triage nurses order radiographs also significantly shortened waiting time in the ED.
-
Comparative Study
Accuracy of bar codes versus handwriting for recording trauma resuscitation events.
To compare the accuracy of computerized bar code data entry with conventional handwritten data entry during videotaped trauma resuscitations. ⋯ Computerized bar code data entry of trauma resuscitation events had significantly fewer entry errors than handwritten data entry in a laboratory setting. Potential advantages of bar code data entry include keyless data entry, automatic time-stamping, standardization of documentation, legibility of the medical record, and "point-of-care" data capture.
-
Case Reports
Severe hypernatremic dehydration and hyperkalemia in an infant with gastroenteritis secondary to rotavirus.
A case of severe hypernatremic dehydration (sodium, 191 mmol/L) with associated severe hyperkalemia (potassium, 11.2 mmol/L) and hyperosmolality (502 mOsm/kg) is described in a 3-month-old infant secondary to acute infection with rotavirus. The patient was managed with i.v. fluid resuscitation in conjunction with intracranial pressure monitoring and was discharged well and without any permanent sequelae. Review of the literature reveals the case described to be the most profound example of hypernatremic dehydration with a favorable outcome reported from diarrheal illness. Strategies for management of hypernatremic dehydration are discussed.
-
Comparative Study
Prognostic value of the emergency department cardiogram for in-hospital complications of acute myocardial infarction [corrected].
To identify patients who are admitted from the emergency department with chest discomfort who are at low risk for life-threatening complications. ⋯ Patients who meet low-risk group criteria have a low likelihood of immediate life-threatening events and could be admitted to an intermediate care unit.
-
To evaluate the safety and effectiveness of the Combitude as used by ICU nurses under medical supervision compared with endotracheal airway established by ICU physicians during CPR. ⋯ The Combitube as used by ICU nurses was as effective as establishment of the endotracheal airway by intensivists during CPR. The Combitube may be used whenever endotracheal intubation cannot be performed immediately.