Annals of emergency medicine
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Shock index (SI) (heart rate/systolic blood pressure; normal range, 0.5 to 0.7) and conventional vital signs were compared to identify acute critical illness in the emergency department. ⋯ With apparently stable vital signs, an abnormal elevation of the SI to more than 0.9 was associated with an illness that was treated immediately, admission to the hospital, and intensive therapy on admission. The SI may be useful to evaluate acute critical illness in the ED.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of intranasal sufentanil and midazolam to intramuscular meperidine, promethazine, and chlorpromazine for conscious sedation in children.
To compare intranasal sufentanil and midazolam (IN-SM) with intramuscular meperidine, promethazine, and chlorpromazine (IM-MPC) for sedation in children. ⋯ IN-SM is as effective as IM-MPC for sedation in children.
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To assess the need for cranial computed tomography (CT) in the emergency department evaluation of children with Glasgow Coma Scale (GCS) score of 15 after mild head injury with loss of consciousness. ⋯ The prevalence of intracranial hemorrhage in children with mild closed-head injury appears to vary with the presence of neurologic abnormalities and other noncranial injuries. After isolated head injury with loss of consciousness, children older than 2 years who are neurologically normal and without signs of depressed or basilar skull fracture may be discharged home from the ED without a cranial CT scan after careful physical examination alone.
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Comparative Study
Evaluation of a new rapid quantitative immunoassay for serum myoglobin versus CK-MB for ruling out acute myocardial infarction in the emergency department.
To compare the predictive values of serum myoglobin and creatine kinase (CK)-MB for ruling out acute myocardial infarction in the emergency department. ⋯ In the first hour of presentation to the ED, the rapid quantitative assay for S-Mgb was statistically more sensitive than CK-MB and had an excellent negative predictive value for ruling out acute myocardial infarction in patients with typical or atypical symptoms. Due to the relatively small sample size, we could not exclude the possibility that differences in specificity might become statistically significant (beta error) with a larger sample size of acute myocardial infarction patients.