The American journal of emergency medicine
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Randomized Controlled Trial Clinical Trial
A blinded, randomized, paired, placebo-controlled trial of 20-minute EMLA cream to reduce the pain of peripheral i.v. cannulation in the ED.
A eutectic mixture of local anesthetics (EMLA) in cream form has been used as a topical anesthetic to reduce the pain of procedures penetrating the skin. It is generally applied for 45 to 60 minutes before the painful procedure. The purpose of this study was to determine whether a 20-minute application of EMLA is useful in reducing the pain of routine peripheral intravenous cannulation in the emergency department (ED). ⋯ These data failed to demonstrate any significant benefit of EMLA compared with placebo. EMLA is not useful for intravenous cannulation when used for 20-minute application times. There may be more effective and less costly ways of reducing the pain of intravenous cannulation that patients would prefer.
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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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Emphysematous cystitis is a rare disorder most commonly seen in women and associated with urinary tract infections and poorly controlled diabetes mellitus. We report the case of a 76-year-old woman who presented with diarrhea and abdominal discomfort, and emphysematous cystitis was revealed on the abdominal X-ray series. ⋯ As the patient was treated for emphysematous cystitis (bladder irrigation and intravenous antibiotics), the diarrhea rapidly resolved and the radiographic abnormalities of the emphysematous cystitis also resolved. This may suggest a causal relationship, although a specific mechanism is unknown.