Annals of emergency medicine
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Randomized Controlled Trial
The role of oral ondansetron in children with vomiting as a result of acute gastritis/gastroenteritis who have failed oral rehydration therapy: a randomized controlled trial.
We hypothesize that ondansetron will facilitate oral rehydration therapy in children with acute gastritis or acute gastroenteritis and mild to moderate dehydration who fail initial oral rehydration therapy. We hypothesize that subjects receiving ondansetron will tolerate oral rehydration and that a lower proportion will require intravenous hydration than subjects receiving placebo, with a clinically important difference of at least 30% when comparing 2 groups of patients presenting to the ED with acute gastritis/acute gastroenteritis. Secondarily, we hypothesize that subjects receiving ondansetron will have a lower proportion requiring admission, fewer episodes of vomiting and diarrhea, and fewer revisits. ⋯ In subjects with acute gastritis/acute gastroenteritis and mild to moderate dehydration who failed initial oral rehydration therapy, the proportion of children who received intravenous hydration was smaller in the ondansetron group than in the placebo group.
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Randomized Controlled Trial
The utility of supplemental oxygen during emergency department procedural sedation with propofol: a randomized, controlled trial.
We determine whether supplemental oxygen reduces the incidence of hypoxia by 20% compared with breathing room air in adult study patients receiving propofol for emergency department procedural sedation. ⋯ Supplemental oxygen (3 L/minute) trended toward reducing hypoxia in adult study patients; however, the 10% difference observed was not statistically significant and was below our a priori 20% threshold. Blinded capnography frequently identified respiratory depression undetected by the treating physicians.
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WHAT IS ALREADY KNOWN ON THIS TOPIC: Procalcitonin is a biomarker that appears to correlate with bacterial infection. WHAT QUESTION THIS STUDY ADDRESSED: Does a procalcitonin level add prognostic information for pneumonia patients in conjunction with scoring systems such as the Pneumonia Severity Index or CURB-65? WHAT THIS STUDY ADDS TO OUR KNOWLEDGE: Among 1,651 patients with community-acquired pneumonia in 28 US emergency departments, procalcitonin levels did not add prognostic information for most pneumonia patients. ⋯ HOW THIS MIGHT CHANGE CLINICAL PRACTICE: Clinicians should continue using validated prognostic scoring systems for pneumonia. Low procalcitonin level could be considered as a factor for selected patients who would otherwise be considered high risk to be treated in a lower acuity setting.
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Randomized Controlled Trial
Effect of ondansetron on the incidence of vomiting associated with ketamine sedation in children: a double-blind, randomized, placebo-controlled trial.
We investigate the effect of ondansetron on the incidence of vomiting in children who receive intravenous (IV) ketamine for procedural sedation and analgesia in the emergency department (ED). ⋯ IV ondansetron significantly reduces the incidence of vomiting associated with IV ketamine procedural sedation in children.