The American journal of emergency medicine
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Clinical Trial Controlled Clinical Trial
Provision for clinic patients in the ED produces more nonemergency visits.
This study sought to evaluate how the addition of a general practitioner (GP) surgery influences the utilization of an emergency department (ED). An intervention trial with historical control was conducted in a Swedish university hospital ED. A GP surgery was established in the ED by the addition of GP physicians without the addition of other personnel (nurses, secretaries, aids). ⋯ The percentage of patients managed in the ED who had nonurgent complaints (primary health care needs) increased with the intervention from 22% (95% confidence interval [CI] 19%, 25%) to 33% (95% CI 30%, 37%). The increased demand on the ED of patients with nonurgent complaints increased the average waiting time for patients with urgent or emergent complaints from 35 minutes to 40 minutes (14%). The introduction of GPs to an ED increased the number and proportion of patients presenting to the ED with nonurgent complaints.
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The pulse oximeter has become an essential tool in the modern practice of emergency medicine. However, despite the reliance placed on the information this monitor offers, the underlying principles and associated limitations of pulse oximetry are poorly understood by medical practitioners. ⋯ The accuracy of pulse oximetry is discussed in light of these factors, with further discussion of applications for pulse oximetry in emergency medicine, including both oximetric and plethysmographic operation. The pulse oximeter is an invaluable instrument for emergency medicine practice, but as with any test the data it offers must be critically appraised for proper interpretation and utilization.
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Case Reports
Congenital diaphragmatic hernia with gastric volvulus presenting as an acute tension gastrothorax.
This report describes a 3-month-old infant with acute severe respiratory distress in whom a diagnosis of congenital diaphragmatic hernia with tension gastrothorax and gastric volvulus was made. A review of the pathophysiology, clinical presentation, differential diagnosis, diagnostic evaluation, and treatment of congenital diaphragmatic hernia is presented.
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of ketorolac tromethamine versus meperidine in the ED treatment of acute renal colic.
To compare the efficacy of intramuscular ketorolac and meperidine in the emergency department (ED) treatment of renal colic, a prospective, controlled, randomized, double-blind trial was conducted in an academic ED with 76,000 annual visits. Participants were volunteer ED patients with a diagnosis of ureterolithiasis confirmed by intravenous pyelogram. Subjects were randomized 1:1 to receive a single intramuscular injection of either 60 mg ketorolac or 100 to 150 mg meperidine, based on weight. ⋯ Similar proportions of patients in each group were given rescue analgesia and admitted. Of patients who were discharged home without rescue, those treated with ketorolac left the ED significantly earlier than those treated with meperidine (3.46 v 4.33 h, P < .05). These results show that intramuscular ketorolac as a single agent for renal colic is more effective than meperidine and promotes earlier discharge of renal colic patients from the ED.