The American journal of emergency medicine
-
Randomized Controlled Trial
Could we use the comfort score instead of the numeric rating pain score? A proof of concept pilot study.
Asking patients about pain in the Emergency Department (ED) when deriving a pain score may aggravate perception of pain due to the nocebo-effect. A strategy for diminishing this nocebo-effect is cognitive reframing. Cognitive reframing of the frequently used pain score (PS) in the ED could theoretically be obtained by using the comfort score (CS). The aim of this study was to evaluate whether or not the CS and PS are interchangeable and therefore, whether or not the CS could safely be used in ED patients. ⋯ This proof of concept study suggest interchangeability of the PS and the ICS in patients with pain in the ED. However, while not statistically significant, 33% of the patients had a possible clinical significant difference in score outcome, potentially over- or underestimating the patients pain. Whether or not this can be used as a tool for cognitive reframing to reduce perception of pain and medication consumption has yet to be studied.
-
Though a circulation-airway-breathing (CAB) resuscitation sequence is now widely accepted in administering CPR over the airway-breathing-circulation (ABC) sequence following cardiac arrest, current evidence and guidelines vary considerably for complex polytraumas, with some prioritizing management of the airway and others advocating for initial treatment of hemorrhage. This review aims to evaluate existing literature comparing ABC and CAB resuscitation sequences in adult trauma patients in-hospital to direct future research and guide evidence-based recommendations for management. ⋯ This study found that hypotensive trauma patients, especially those with active hemorrhage, may benefit more from a CAB approach to resuscitation, as early intubation may increase mortality secondary to PIH. However, patients with critical hypoxia or airway injury may still benefit more from the ABC sequence and prioritization of the airway. Future prospective studies are needed to understand the benefits of CAB with trauma patients and identify which patient subgroups are most affected by prioritizing circulation before airway management.
-
Observational Study
Chest pain observation unit: A missed opportunity to initiate smoking cessation therapy.
Emergency Department Observation Unit (EDOU) patients with chest pain have a high prevalence of smoking, a key cardiovascular disease risk factor. While in the EDOU, there is an opportunity to initiate smoking cessation therapy (SCT), but this is not standard practice. This study aims to describe the missed opportunity for EDOU-initiated SCT by determining the proportion of smokers who receive SCT in the EDOU and within 1-year of EDOU discharge and to evaluate if SCT rates vary by race or sex. ⋯ SCT was rarely initiated in the EDOU among chest pain patients who smoke and most patients who did not receive SCT in the EDOU never received SCT at 1-year of follow-up. Rates of SCT were similarly low among race and sex subgroups. These data suggest an opportunity exists to improve health by initiating SCT in the EDOU.