The American journal of emergency medicine
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Letter Case Reports
Nonconvulsive status epilepticus from accidental lithium ingestion.
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Randomized Controlled Trial Comparative Study Clinical Trial
Subcutaneous lidocaine delivered by jet-injector for pain control before IV catheterization in the ED: the patients' perception and preference.
To evaluate patients' perceptions and preferences concerning pain control during intravenous (IV) catheterization, a sample of 50 adult patients received subcutaneous lidocaine (0.2 mL 1%) by jet injector, or no anesthetic with a sham injection before IV catheterization. Visual analog scale (VAS), pain intensity score (PIS), and adverse reactions were recorded. ⋯ Patients in both groups (84% overall) preferred local anesthesia based on this experience. Using the jet-injector to provide local anesthesia before IV catheterization in the ED is effective, fast, and does not require sharps disposal and handling precautions.
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Comparative Study
Painful discrimination: the differential use of analgesia in isolated lower limb injuries.
Our primary objective was to compare use of analgesia for patients with and without fracture as a result of isolated lower extremity trauma, in the emergency department (ED). Our secondary objective was to compare the analgesic practices of emergency physicians (EPs) with that of physician assistants (PAs). We performed a prospective, blinded cohort study with the presence of fracture as the risk factor and provision of any pain medication while in the ED as the primary outcome. ⋯ Our estimated adjusted ORs for providing analgesia in the ED were: fracture = 2.0 (CI 95% 1.13, 3.58); EP: 3.52 (CI 95% 1.98, 2.99); and for every additional point on the verbal pain scale: 1.28 (CI 95% 1.11, 1.48). Patients with fracture were more likely to receive pain, despite reporting identical degree of pain. EPs were more likely to provide analgesia than PAs.
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Letter Case Reports
Respiratory depression after accidental risperidone overdose.
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Randomized Controlled Trial Comparative Study Clinical Trial
Provision of clinically based information improves patients' perceived length of stay and satisfaction with EP.
We conducted a focused, prospective, randomized study to evaluate whether periodic personal provision of clinically based information to patients during an Emergency Department (ED) visit improves patients' perceptions of physician's excellence and efficiency of patient care. Six hundred nineteen consecutive adult patients or proxy informants, who were evaluated in the ED and subsequently discharged, were randomized into the standard of care (n = 307) and intervention group (n = 312). Under supervision by ED attending physicians, a single research assistant periodically provided patients with process and medical information at 15-minute intervals, starting at arrival and continuing through until discharged from the ED. ⋯ Patients' perception of nursing skills were, however, statistically similar in the 2 groups (Bedside: 83.1% vs. 83.0%, P =.942; Technical skill: 84.5% vs. 82.7%, P =.613). Given the sample size and observed proportions, the chi(2) analysis of perception of nursing skill had a power of 4.8% (registered nurse [RN] bedside) and 7.5% (RN technical skill). Periodic personal interaction and provision of clinically based information in the ED is thought to improve patients' perceived LOS, efficiency, and clinical skills of EP after an ED visit.