The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Salbutamol treatment of acute severe asthma in the ED: MDI versus hand-held nebulizer.
The objectives of this study were to compare the efficacy of salbutamol delivered by either metered-dose inhaler plus spacer (MDI-spacer) or by wet nebulization (NEB), and to determine the relationships between physiologic responses and plasma salbutamol concentrations. Asthmatic patients presenting to the emergency department (ED) with acute severe asthma (forced expiratory volume in the first second [FEV1] less than 50% of predicted) were enrolled in a randomized, double-blind, parallel-group study. The MDI-spacer group received salbutamol, delivered via MDI into a spacer device, in four puffs actuated in rapid succession at 10-minute intervals (2.4 mg/h). ⋯ Additionally, the NEB group presented a higher incidence of tremor (P=.03) and anxiety (P=.04), reflecting larger systemic absorption of salbutamol. These data indicate that when doses used are calculated on the basis of the percentage of total drug that reaches the lower airway, there was equivalent bronchodilatation after salbutamol administered by either MDI-spacer or nebulization in patients with acute severe asthma. However, nebulizer therapy produced greater side effects related to the increase in salbutamol absorption and higher plasma level.
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This study was done to examine the impact of the mini-mental status examination (MMSE) in the emergency department (ED) evaluation of the elderly patient. The study was a prospective study of the MMSE applied by the investigators with a comparison to the findings of the treating physician, in a university hospital ED with annual volume of 60,000. Participants were a convenience sample of patients older than 65 years of age without apparent mental status abnormality presenting to the ED. ⋯ These results show that the MMSE is a valuable screening tool to assess the mental status of the elderly in the ED setting. Unexpected abnormality was noted in a significant minority of patients in this study, altering the patient's course in all instances. The MMSE should be considered in evaluation of all geriatric patients encountered in the ED.
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The objective of this study was to examine the pattern of emergency department (ED) use by frequent ED users over time. This study was a retrospective study of adults with more than 10 visits to a university hospital ED from 8/90 through 7/91. ED visits of this cohort to all hospitals in the metropolitan area were followed for 3 years. ⋯ Fifty-eight percent of patients making more than 10 visits in more than 1 year had psychiatric or substance abuse problems. The pattern of ED use in this cohort changed over time and was influenced by substance abuse and psychiatric problems. These data suggest that most patients do not remain frequent ED users over time.
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The emergency department (ED) care of a patient with a tracheostomy tube can be problematic because of difficulty with patient communication, urgency of airway control, and unfamiliarity with tracheal equipment. The objective of this study was to characterize complications of tracheostomy patients seen in the ED and provide management techniques. A retrospective study was conducted on all patients with tracheostomy complications who presented to a university, tertiary-care ED over a 7-year period. ⋯ During the study period, 35 patients were evaluated in the ED for 60 complications. The 60 complications were categorized into six groups: 20 (33%) patients presented with dislodged tracheal tubes, 11 (18%) presented with plugged tracheal tubes, 18 (30%) had infection, 7 (11%) had bleeding, 1 (3%) had a pnuemothorax, and 3 (5%) had tracheal/stomal stenosis. Review of the complications that place tracheostomy patients at high risk in conjunction with a review of the literature enabled the development of a standard approach to dealing with patients with tracheostomies that can facilitate proper care of the patients in the ED.
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Dissection of the internal carotid artery is responsible for approximately 5% of ischemic strokes in adults. The pathophysiology of dissection can be either traumatic or spontaneous. The true incidence of spontaneous dissection is unknown. ⋯ It is well recognized by neurologists but often not by other physicians. Prognosis is good, but delay in diagnosis may result in residual neurologic deficits. It should therefore be suspected early, especially in younger patients presenting with transient ischemic attacks or stroke.