Annals of emergency medicine
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Patients with intraoral and oral-cutaneous wounds commonly present to emergency departments (EDs), usually after sustaining blunt facial trauma. Many of these wounds are minor, small (<1 cm), hemostatic on presentation, and confined to the oral mucosa, requiring no specific intervention. ⋯ However, studies have shown that other wounds commonly considered to be at significant risk for secondary infection, such as simple lacerations of the hand, do not appear to conclusively benefit from prophylactic antibiotic therapy when careful wound preparation is performed before primary repair. We therefore reviewed the available literature to determine the strength of evidence supporting the use of prophylactic oral antibiotics for intraoral wounds treated and repaired in the ED.
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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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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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Preexisting conditions have been found to be an independent predictor of mortality after trauma. However, no consensus has been reached as to what indicator of preexisting condition status should be used, and the contribution of preexisting conditions to mortality prediction models is unclear. This study aims to identify the most accurate way to model preexisting condition status to predict inhospital trauma mortality and to evaluate the potential gain of adding preexisting condition status to a standard trauma mortality prediction model. ⋯ Preexisting condition status is an independent predictor of mortality from trauma that provides a modest improvement in mortality prediction. The total number of preexisting conditions is a good summary measure of preexisting condition status. The Charlson Comorbidity Index is no better than the total number of preexisting conditions and is therefore not recommended for use in trauma mortality modeling.
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This clinical policy from the American College of Emergency Physicians is an update of a 2002 clinical policy on the evaluation and management of adult patients presenting to the emergency department (ED) with acute, nontraumatic headache. A writing subcommittee reviewed the literature to derive evidence-based recommendations to help clinicians answer the following 5 critical questions: (1) Does a response to therapy predict the etiology of an acute headache? (2) Which patients with headache require neuroimaging in the ED? (3) Does lumbar puncture need to be routinely performed on ED patients being worked up for nontraumatic subarachnoid hemorrhage whose noncontrast brain computed tomography (CT) scans are interpreted as normal? (4) In which adult patients with a complaint of headache can a lumbar puncture be safely performed without a neuroimaging study? (5) Is there a need for further emergent diagnostic imaging in the patient with sudden-onset, severe headache who has negative findings in both CT and lumbar puncture? Evidence was graded and recommendations were given based on the strength of the available data in the medical literature.