Annals of emergency medicine
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Recent studies have proposed the use of D-dimer as a screening tool to "rule out" acute aortic dissection, claiming a sensitivity approaching 100%. We reviewed the literature to determine whether D-dimer can be used as the sole screening tool for acute aortic dissection. An Ovid MEDLINE search, 1966 to present, was performed with the key words "aortic dissection," "fibrin degradation products," and "D-dimer," limited to "human" and "English language." Ten original research articles were identified that directly addressed the use of D-dimer in acute aortic dissection. ⋯ However, 38% of dissections are missed on initial evaluation, and there are no validated clinical decision rules for the clinical diagnosis of acute aortic dissection. Clinical suspicion and chest radiograph findings were the only tools for determining which patients require further imaging until recent studies proposed the use of D-dimer as a screening tool for acute aortic dissection, claiming a sensitivity approaching 100%. Our goal was to evaluate the current literature for the use of D-dimer as the sole screening tool for acute aortic dissection.
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Multicenter Study Comparative Study
A comparison of observed versus documented physician assessment and treatment of pain: the physician record does not reflect the reality.
The Joint Commission requires "appropriate assessment" of patients presenting with painful conditions. Compliance is usually assessed through retrospective chart analysis. We investigate the discrepancy between observed physician pain assessment and that subsequently documented in the medical record. ⋯ Physicians almost always assess and treat patient pain but infrequently record those efforts. The patient's chart is a poor surrogate marker for pain assessment and care by emergency physicians and may not be suitable for use as a compliance assessment tool. Research methodology using retrospective chart analysis may be affected by this phenomenon, suggesting the potential for underestimation of patient pain assessment and treatment by emergency physicians.
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Randomized Controlled Trial
A prospective, randomized trial of an emergency department observation unit for acute onset atrial fibrillation.
An emergency department (ED) observation unit protocol for the management of acute onset atrial fibrillation is compared with routine hospital admission and management. ⋯ An ED observation unit protocol that includes electrical cardioversion is a feasible alternative to routine hospital admission for acute onset of atrial fibrillation and results in a shorter initial length of stay.
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Randomized Controlled Trial
Abdominal compression effectively increases the size of the common femoral vein, as measured by ultrasonography.
We determine the effect of abdominal compression on common femoral vein cross-sectional area. The effects of Valsalva maneuver and reverse Trendelenburg's position are also studied. ⋯ Abdominal compression increases the cross-sectional area of the common femoral vein, and the reverse Trendelenburg's position has a further additive effect. Abdominal compression may be useful when femoral venous cannulation is attempted. In patients who can comply, the Valsalva maneuver may be even more effective.