The American journal of emergency medicine
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Mechanical ventilation is frequently initiated by emergency physicians. Further, the physician on duty in the emergency department is frequently responsible for evaluating ventilated patients who decompensate in the intensive care unit when other physicians are not present in the hospital. ⋯ Knowledge of the pathophysiology of acute respiratory failure and changes in lung physiology during positive pressure ventilation will aid the emergency physician in choosing an appropriate ventilator modality and initial settings to maximally benefit patients with respiratory insufficiency due to various causes. An appreciation of the adverse effects of mechanical ventilation and problems commonly encountered in patients on ventilators will prepare the emergency physician to rapidly assess and effectively manage the patient who deteriorates in this setting.
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Randomized Controlled Trial Clinical Trial
Does warming local anesthetic reduce the pain of subcutaneous injection?
The most frequent complaint noted with the use of lidocaine (or other amide local anesthetic) is stinging or burning pain associated with subcutaneous infiltration. The purpose of this study was to evaluate the efficacy of warming buffered lidocaine for reducing the pain of infiltration. Forty adult volunteers were entered into a randomized, crossover study conducted at a community teaching hospital. ⋯ The order or the initial side of the injection did not influence the pain scores. The study had a power of 80% to detect a 10-mm difference between the two solutions at alpha = .05. These results suggest that warming buffered lidocaine to body temperature (37 degrees C) does not reduce the pain of subcutaneous infiltration.
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Clinical Trial Controlled Clinical Trial
Are emergency departments really a "safety net" for the medically indigent?
This study was designed to quantify the willingness of emergency departments (EDs) and private care practitioners to see medically indigent patients. Three case scenarios were developed to represent severe, moderate, and mild problems that typically confront ED physicians. A female investigator made telephone calls using these scenarios, each time declaring herself to be medically indigent. ⋯ Private practitioners in the largest communities were significantly more reluctant to see the medically indigent than their peers in smaller communities (P < .05). For an insured caller, 55% of private practitioners would see the caller for < $30 and only 35% were not taking new patients or provided referral. In contrast to most private primary care practitioners, EDs are at least willing to serve as a triage point for the medically indigent and are often the primary-care "safety net" for the medically indigent.