Annals of emergency medicine
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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.
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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.
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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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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.