Annals of emergency medicine
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Randomized Controlled Trial Multicenter Study
A randomized controlled trial of prochlorperazine versus metoclopramide for treatment of acute migraine.
We compare prochlorperazine 10 mg intravenously versus metoclopramide 20 mg intravenously for the emergency department (ED) treatment of acute migraine. ⋯ Either prochlorperazine 10 mg intravenously or metoclopramide 20 mg intravenously, combined with diphenhydramine 25 mg intravenously, is an efficacious treatment for ED patients with acute migraine. Three quarters of subjects in both arms would want the same medication for their next migraine.
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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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Letter Case Reports
Ciguatera poisoning successfully treated with delayed mannitol.
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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.