The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study
Comparison of local anesthetic effect of lidocaine by jet injection vs needle infiltration in lumbar puncture.
Usual routes of drug administration are often painful and invasive. Nowadays, using jet injection has been introduced successfully, as a noninvasive and painless method of anesthetic delivery in performing different procedures. ⋯ Injecting lidocaine by jet injector is less painful than infiltrating it by needle and syringe.
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Randomized Controlled Trial
Effect of head position on the success rate of blind intubation using intubating supraglottic airway devices.
To evaluate the effect of head position on the performance of intubating supraglottic airway devices, we compared the success rate of blind intubation in the head-elevated and the pillowless head positions with the LMA Fastrach and the air-Q, and the change of glottic visualization through the air-Q. ⋯ Although the head-elevated position improved glottic visualization in the air-Q, the head position had minimal influence on the success rate of blind intubation with either the Fastrach or the air-Q.
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Per the American Heart Association guidelines, blood pressure (BP) should be less than 185/110 to be eligible for stroke thrombolysis. No studies have focused on prehospital BP and its impact on door to needle (DTN) times. We hypothesized that DTN times would be longer for patients with higher prehospital BP. ⋯ Higher prehospital BP is associated with prolonged DTN times and DTN time remains prolonged if prehospital BP greater than or equal to 185/110 is untreated before ED arrival. Prehospital BP control could be a potential area for improvement to reduce DTN times in patients with acute ischemic stroke.
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We conducted a pilot study to test the interrater reliability of emergency department (ED) physician assessments of 3 ED visit attributes-severity, immediacy, and ideal setting, with the long-term goal of developing a novel ED categorization system. ⋯ Rater agreement among ED physicians when assessing clinical data on specific ED visits was fair for severity and immediacy ratings. Raters agreed on ideal treatment settings half the time. In general, there was greater agreement when a specific diagnosis was found rather than negative workups for symptoms. This demonstrates a validity issue when it comes to developing and using categorization systems for ED visits and assessing setting appropriateness.