The American journal of emergency medicine
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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.
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A prospective, consecutive study was performed to determine if medical student supervision in the emergency department (ED) changes patient throughput time (ie, the time from triage to discharge). The mean patient throughput time on days when medical students were present in the ED (group 1) was compared to the mean patient throughput time on days when medical students were absent from the ED (group 2). Throughput time was measured in minutes. ⋯ The two groups were also compared for mean daily acuity (as gauged by mean daily number of patient admissions) and mean daily patient census. The differences in mean daily throughput times (group 1, 145.2 min v group II, 150.6 min; P = .40), mean daily census (group 1, 28.1 patients v group 2, 28.1 patients; P = .75), and mean daily admissions (group 1, 10.4 patients v group 2, 10.7 patients; P = .74) were all insignificant. Precepting medical students in this ED did not significantly change patient throughput times.
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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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This study was conducted to evaluate the blood urea nitrogen/creatinine (BUN/Cr) ratio for distinguishing an upper versus lower source of gastrointestinal (GI) bleeding. Charts of patients who presented to the emergency department (ED) with the diagnosis of GI bleeding from August 1995 to August 1996 were retrospectively reviewed for source of bleeding, initial BUN, Cr, BUN/Cr ratio, hematocrit (Hct), and need for transfusion. A total of 124 patients were eligible for inclusion, 71 (57%) of whom were male. ⋯ Upper GI bleeding was significantly correlated with age younger than 50 (P = .01) and male gender (P = .01; odds ratio, 3.13). Taking into account age and gender, the BUN/Cr ratio correlated significantly with an upper GI source of bleeding (P = .03), with a ratio greater than 36 having a sensitivity of 90% and a specificity of 27%. The area under the receiver operating characteristic curve using age, gender, and BUN/Cr ratio was .73 (95% confidence interval, .62 to .84).