Annals of emergency medicine
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Randomized Controlled Trial Clinical Trial
Reducing the pain of local anesthetic infiltration: warming and buffering have a synergistic effect.
To compare room-temperature unbuffered lidocaine, warm lidocaine, buffered lidocaine, and warm buffered lidocaine to determine which of the four solutions is least painful during infiltration. ⋯ Skin infiltration with warm buffered lidocaine is significantly less painful than infiltration with room-temperature unbuffered lidocaine, warm lidocaine, or buffered lidocaine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Suprapubic bladder aspiration versus urethral catheterization in ill infants: success, efficiency and complication rates.
To compare success rates, complications, and efficiency of suprapubic bladder aspiration with urethral catheterization in ill infants. ⋯ Both suprapubic bladder aspiration and urethral catheterization afford the emergency physician low-risk access to uncontaminated urine in ill infants. Suprapubic bladder aspiration is less efficient in that it requires physician participation and failure rates are higher. These data suggest that successful suprapubic bladder aspiration is primarily dependent on the volume of urine in the bladder; thus, in the ill or febrile ED infant who may be dehydrated, the likelihood of success decreases. The authors recommend that ED nursing and physician staff become comfortable with performing urethral catheterization on infants.
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Randomized Controlled Trial Comparative Study Clinical Trial
Indomethacin suppositories versus intravenously titrated morphine for the treatment of ureteral colic.
To develop a protocol for the blinded IV titration of morphine and to compare the analgesic efficacy and side effect profile of indomethacin suppositories versus IV morphine in the treatment of acute ureteral colic. ⋯ IV morphine produced more rapid analgesia than rectally administered indomethacin. There were no significant differences in vital sign changes or number of side effects between the two treatment groups. This study is the first to compare an NSAID with morphine administered by IV titration, considered by many to be the "gold standard" for relief of acute, severe pain. Future studies could evaluate the simultaneous administration of an opioid combined with an NSAID or compare an IV titrated opioid with an IV NSAID.
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Randomized Controlled Trial Comparative Study Clinical Trial
Neuromuscular blockade-assisted oral intubation versus nasotracheal intubation in the prehospital care of injured patients.
To compare nasotracheal intubation (NTI) to neuromuscular blockade-assisted oral intubation (NMB-assisted oral intubation) in the prehospital care of injured patients. ⋯ In the prehospital management of severely injured patients, there is no significant difference between NMB-assisted oral intubation and NTI in the rate at which endotracheal intubation is achieved. However, practitioners may prefer NTI because it requires significantly less time to perform than NMB-assisted oral intubation.
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Randomized Controlled Trial Multicenter Study Clinical Trial
A clinical trial of escalating doses of flumazenil for reversal of suspected benzodiazepine overdose in the emergency department.
To determine if flumazenil, when used in doses higher than those currently recommended, could reverse the effects of a benzodiazepine (BDZ) overdose in patients who might not otherwise respond and whether the higher dose was associated with increased adverse effects. ⋯ Flumazenil rapidly and effectively reverses the clinical signs and symptoms of a BDZ overdose. Most patients will respond to 3 mg or less, but a small number may require a higher dose for reversal of clinical symptoms. Patients with concomitant tricyclic antidepressant overdose may be at risk for developing seizures.