The American journal of emergency medicine
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Randomized Controlled Trial
Less painful arterial blood gas sampling using jet injection of 2% lidocaine: a randomized controlled clinical trial.
The aim of this study was to compare pain levels from arterial blood gas (ABG) sampling performed with or without application of lidocaine via jet injector. ⋯ Lidocaine jet injection provides beneficial and rapid anesthesia, resulting in less pain and a greater rate of successful ABG sampling. Therefore, it is recommended for use before ABG sampling to decrease the patient's pain and the number of unsuccessful attempts and to enhance the patient's satisfaction.
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Hand injuries are a common complaint in the emergency department (ED). Oftentimes, these injuries occur in work settings. ⋯ Using bedside fluoroscopy, the thumb carpometacarpal joint was isolated, injected, and subsequently reduced. The clinical course and management are discussed as well as a brief review of hand injuries.
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Hospitals implement electronic medical record systems (EMRSs) that are intended to support medical and nursing staff in their daily work. Evolution toward more computerization seems inescapable. Nevertheless, this evolution introduced new problems of organization. ⋯ In the satisfaction questionnaire, clinicians reported minimal satisfaction but refused to return to handwritten records. The increase in door-to-FMC time may be explained by the improved quantity/quality of data and by the many interruptions due to the software. Medical reorganization was requested after the installation of the EMRS.
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A 46-year-old man presented to the emergency department after being injured with a press machine from his left hand 30 minutes before admission. Subungual hematoma was diagnosed in his index finger, although the nail plate was intact. Emergency physicians could identify nail bed injury with bedside ultrasonography examination. This noninvasive, inexpensive, and repeatable diagnostic modality could preserve patients from a complex, invasive nail removal procedure.
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A small number of patients representing a significant demand on emergency department (ED) services present regularly for a variety of reasons, including psychiatric or behavioral complaints and lack of access to other services. A care plan program was created as a database of ED high users and patients of concern, as identified by ED staff and approved by program administrators to improve care and mitigate ED strain. ⋯ An alert program that identifies challenging ED patients with psychiatric conditions and creates a care plan appears to reduce visits and lead to more appropriate use of other resources.