The American journal of emergency medicine
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Meta Analysis Comparative Study
Effects of long axis in-plane vs short axis out-of-plane techniques during ultrasound-guided vascular access: preliminary evidence.
Currently, whether long-axis in-plane (LA-IP) is superior to short-axis out-of-plane (SA-OOP) during ultrasound-guided vascular access remains inconclusive. We, therefore, conducted a meta-analysis of randomized controlled trials to compare the effects of LA-IP vs SA-OOP techniques in patients undergoing ultrasound-guided vascular access (USGVA). ⋯ There is insufficient evidence to definitively choose either LA-IP or SA-OOP in patients undergoing USGVA. Further robustly well-designed trials are warranted to investigate the appropriate technique in patients receiving USGVA.
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Randomized Controlled Trial
Topical ethyl chloride to reduce pain associated with venous catheterization: a randomized crossover trial.
To compare pain associated with venous catheterization after administration of topical ethyl chloride vs placebo among emergency department health care providers. ⋯ We found that topical ethyl chloride yields a greater reduction in pain associated with venous catheterization compared with topical placebo.
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We discuss a case of a 20-year-old woman presenting with chest pain found to have a Hampton's hump on chest x-ray and corresponding wedge infarct on computed tomographic scan. Contrary to our suspicion that this febrile and tachycardic patient had a pulmonary embolism, she was later determined to have a septic embolus secondary to endocarditis. We highlight the difficulties in diagnosing certain cases of endocarditis in the emergency department, as well as the difficulties in distinguishing septic emboli from pulmonary emboli,especially with plain radiographs.
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Clinical Trial
Usefulness of new and traditional serum biomarkers in children with suspected appendicitis.
The objective of the study is to evaluate the usefulness of the leukocyte (white blood count [WBC]) and neutrophil (absolute neutrophil count [ANC]) counts; the values of C-reactive protein (CRP), procalcitonin, and calprotectin (CP); and the APPY1 Test panel of biomarkers, to identify children with abdominal pain at low risk for appendicitis. ⋯ The APPY1 Test panel with ANC could be useful in identifying children with abdominal pain suggestive of AA who are at low risk for this disease.