The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study
A comparison of longitudinal and transverse approaches to ultrasound-guided axillary vein cannulation.
The axillary vein is an easily accessible vessel that can be used for ultrasound-guided central vascular access and offers an alternative to the internal jugular and subclavian veins. The objective of this study was to identify which transducer orientation, longitudinal or transverse, is better for imaging the axillary vein with ultrasound. ⋯ The longitudinal method of visualizing the axillary vein during ultrasound-guided venous access is associated with greater first-attempt success, fewer needle redirections, and a trend of fewer arterial punctures compared with the transverse orientation.
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The aim of this study was to develop a strategy for imposing peer pressure on emergency physicians to discharge patients and to evaluate patient throughput before and after intervention. ⋯ The intervention strategy used peer pressure to enhance patient flow and throughput. More patients were discharged at the end of shifts, particularly triage level III patients. The ED LOS for patients whose final disposition was discharge decreased significantly.
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Cocaine is the most commonly abused illegal drug in patients presenting to emergency departments (EDs) because of chest pain and accounts for almost 40% of all drug-related visits. It is not known whether all β-blockers (BB) and β1-selective agents or mixed α1/β-adrenergic antagonists (α1/β-BB) are safe in the acute management of cocaine-associated chest pain, due to concerns of unopposed α-receptor activity resulting in coronary artery spasm and hypertensive urgency. ⋯ Troponin rise is not uncommon in patients with cocaine-associated chest pain and occurred in 11% of the patients. In patients with cocaine-associated chest pain, BBs did not appear to change the incidence of troponin rise. β1-Selective BBs did not appear to worsen troponin levels compared with mixed α1/β-BB.
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We sought to identify barriers and delays in care associated with the increased prevalence of perforated appendicitis among Colorado's pediatric Medicaid population. ⋯ The high prevalence of perforated appendicitis in Colorado children with Medicaid coverage is not associated with race or physical proximity to care but may be associated with the duration of Medicaid coverage, which highlights the importance of establishing medical homes to direct patients on where and how to seek care.