The American journal of emergency medicine
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Clinical Trial Controlled Clinical Trial
Does a physician visual assessment change triage?
A prospective comparative trial was conducted to determine the effect of a physician's visual assessment of emergency patients on triage categorization and ability at triage to predict admission. The setting was a university, county, referral center and residency training site. Participants were a consecutive sample of emergency department patients presenting between the times of 0700 and 2300 hours for 5 weeks. ⋯ When physician visual assessment was done, agreement between physicians and nurses decreased by more than half. Physicians who included visual assessment in patient triage were less likely to agree with RN categorization. A visual assessment by the physician improved the sensitivity for predicting admission with an only small cost in specificity.
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Transnasal butorphanol (TNB) is a mixed agonist-antagonist opioid that has recently been released for the treatment of painful conditions. Patients with a history of migraine diagnosed in either of two emergency departments (EDs) with a moderate or severe migraine were eligible for this prospective study. Patients received 1 mg of TNB at time zero and again in 45 minutes if needed. ⋯ Thirty-six percent experienced side effects, with all but 1 being mild or moderate. Seventy-five percent rated the treatment as good, very good, or excellent, and 71% would prefer to receive TNB for future migraines over other treatment options. TNB offers rapid, effective pain relief to the majority of ED migraine patients.
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Nasal foreign bodies requiring removal occur commonly in young children. Different techniques of removal are needed depending on the type of nasal foreign body. A retrospective chart review of a 19-month period identified 60 pediatric patients with nasal foreign bodies evaluated in a pediatric emergency department. ⋯ Most foreign bodies can be managed with simple equipment and without requiring otolaryngology consultation. Because of the many different nasal foreign bodies found, the physician should be skilled in numerous techniques of removal. Each one of these useful techniques is reviewed.