The American journal of emergency medicine
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Inadequate treatment of pain, which has been termed as "oligoanalgesia", appears to be common in a number of practice settings, including the emergency department (ED). The purpose of this study was to determine whether elderly patients with isolated long-bone fractures are less likely to receive analgesics in the ED than a similar cohort of younger patients. Consecutive adult patients (aged 20 to 50 years or older than 70 years) presenting to the ED with isolated long-bone fractures were evaluated using a retrospective cohort study design. ⋯ Younger patients also tended to receive more narcotic medications (98% vs 89%, P = .03). Inadequate use of analgesics in adult ED patients with acute fractures appears to be common. A chronologic basis for variability in analgesic practice needs to be further characterized.
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The appropriateness of aggressive resuscitation in many clinical settings has been questioned. Survival rates from cardiac arrest in the elderly are generally reported as poor, and satisfactory results from resuscitation attempts prolonged beyond 15 minutes are said to be rare. It was the purpose of this study to examine success rates for resuscitation in a cohort of elderly inpatients suffering cardiac arrest. ⋯ No significant difference in age or presenting rhythm of survivors versus nonsurvivors could be demonstrated, although a trend to more frequent ventricular fibrillation or ventricular tachycardia was seen (P = .059, Fisher's exact). Time for resuscitation averaged 25.75 +/- 9.2 minutes for survivors and 32.6 +/- 22.1 minutes for nonsurvivors. Survival to hospital discharge occurs in 9% of in-hospital cardiac arrests in the elderly following average CPR times substantially in excess of 15 minutes.