The American journal of emergency medicine
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Acute ST-segment elevation myocardial infarction continues to be associated with substantial mortality rates. Despite much advancement in care, current treatments have also failed to eliminate the significant risk of morbidity, including reinfarction, reocclusion of the infarct-related artery, and thromboembolic stroke. The potential benefit of early thrombolytic therapy in reducing mortality was first established in 1986. ⋯ This review examines the most significant trends in the pharmacologic therapy of ST-segment elevation myocardial infarction since the publication of these early studies: the development of fibrinolytic drugs with improved clot selectivity and improved pharmacokinetic profiles that simplify administration, making ED or even prehospital thrombolysis more practical. More recent data can be interpreted as showing that regimens that are simpler and easier to administer are also clinically superior. This article reviews pharmacologic advances and evaluates the evidence for their use in EDs.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, randomized pilot evaluation of topical triple antibiotic versus mupirocin for the prevention of uncomplicated soft tissue wound infection.
Little data exists comparing the safety and efficacy of triple antibiotic ointment (TAO) and mupirocin for prevention of uncomplicated soft tissue wound infections. The purpose of this investigation was to conduct a pilot study of the relative safety, efficacy, and cost effectiveness of the 2 preparations. This was a randomized, prospective, interventional study to determine the difference in infection rates of uncomplicated soft tissue wounds between subjects treated with TAO and mupirocin ointment after standard wound care and suturing. ⋯ There were no serious adverse effects in either group. This pilot study found a similar rate of wound infection and adverse events between TAO and mupirocin ointments. Results should be confirmed in a larger equivalency trial.
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Randomized Controlled Trial Clinical Trial
Low risk of infection in selected human bites treated without antibiotics.
To assess the need for antibiotics in low-risk human bite wounds, a prospective, double-blind, placebo-controlled study involving 127 patients presenting with low-risk human bite wounds over 2 years to a 40,000 visit per year major academic ED was performed. Low-risk bites penetrated only the epidermis and did not involve hands, feet, skin, overlying joints, or cartilaginous structures. Exclusion criteria included age less than 18 years, puncture wounds, immunocompromise, allergy to penicillin or related compound, or bites greater than 24 hours old. ⋯ Infection developed in 0 of 63 patients receiving the cephalexin/penicillin combination (0%, 95% CI, 0-4.6%). Antibiotic treatment of some low-risk human bite wound could be unnecessary. Infection rates appear similar in low-risk human bite wounds whether treated with antibiotics or placebo.
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Recent regulatory and legal scrutiny has raised concerns about the over- and undertreatment of pain in the hospital. This debate stems from either the overly aggressive approach to the management of pain with opioids or, alternatively, to the barriers preventing the appropriate prescribing of these medications. ⋯ Accordingly, they must apprise themselves of pain management skills and continue to help those in need of appropriate medications while thwarting inappropriate prescribing. This review offers a synopsis of the pitfalls associated with ED pain management and provides recommendations for selected conditions.
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Obesity is a major health care problem in the United States. The body mass index (BMI) is the standard measure of obesity. ⋯ Given the incidence of obesity in the general population, it is likely that EM physicians will be involved in the emergency care of critically ill or injured obese patients. The objective of this article is to present the clinical problems associated with the resuscitation of the critically ill or injured obese patient and their potential solutions.