Annals of emergency medicine
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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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Numerous investigators have evaluated the ECG algorithm described by Sgarbossa et al to predict acute myocardial infarction in the presence of left bundle branch block and have arrived at divergent conclusions. To clarify the utility of the Sgarbossa ECG algorithm, we perform a systematic review and meta-analysis of these trials. ⋯ A Sgarbossa ECG algorithm score of greater than or equal to 3, representing greater than or equal to 1 mm of concordant ST elevation or greater than or equal to 1 mm ST depression in leads V1 to V3, is useful for diagnosing acute myocardial infarction in patients who present with left bundle branch block on ECG. The scoring system demonstrates good to excellent overall interobserver variability. A score of 2, representing 5 mm or more of discordant ST deviation, demonstrated ineffective positive likelihood ratios. A Sgarbossa ECG algorithm score of 0 is not useful in excluding acute myocardial infarction.
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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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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.
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Clinical Trial
Emergency clinician-performed compression ultrasonography for deep venous thrombosis of the lower extremity.
Emergency clinician-performed ultrasonography holds promise as a rapid and accurate method to diagnose and exclude deep venous thrombosis. However, the diagnostic accuracy of emergency clinician-performed ultrasonography performed by a heterogenous group of clinicians remains undefined. ⋯ The overall diagnostic accuracy of single-visit emergency clinician-performed ultrasonography performed by a heterogeneous group of ED clinicians is intermediate but may be improved by pretest probability assessment.