Annals of emergency medicine
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Randomized Controlled Trial Comparative Study
Sublingual buprenorphine in acute pain management: a double-blind randomized clinical trial.
We compare the efficacy and safety of sublingual buprenorphine versus intravenous morphine sulfate in emergency department adults with acute bone fracture. ⋯ For adults with acute fractures, buprenorphine 0.4 mg sublingually is as effective and safe as morphine 5 mg intravenously.
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Chest pain units have been used to monitor and investigate emergency department (ED) patients with potential ischemic chest pain to reduce the possibility of missed acute coronary syndrome. We seek to optimize the use of hospital resources by implementing a chest pain diagnostic algorithm. ⋯ In ED patients with chest pain, a structured diagnostic approach with time-focused ED decision points, brief observation, and selective application of early outpatient provocative testing appears both safe and diagnostically efficient, even though some patients with acute coronary syndrome may be discharged for outpatient stress testing on the index ED visit.
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Advanced, out-of-hospital procedures such as intravenous access are commonly performed by emergency medical services (EMS) personnel, yet little evidence supports their use among noninjured patients. We evaluate the association between out-of-hospital, intravenous access and mortality among noninjured, non-cardiac arrest patients. ⋯ In this population-based cohort, out-of-hospital efforts to establish intravenous access were associated with a reduction in hospital mortality among noninjured, non-cardiac arrest patients with the highest acuity. Reasons why this occurred (cause and effect) could not be determined in this model.