Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of proparacaine and tetracaine eye anesthetics.
To compare two topical eye anesthetics, proparacaine and tetracaine, for pain of instillation and duration of activity. ⋯ Proparacaine eye drops cause less pain than tetracaine eye drops upon instillation. Anesthesia from proparacaine last slightly longer. These properties make proparacaine preferable to tetracaine.
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In clinical practice, thoracotomy and other critical emergency procedures are rarely required. Consequently, medical students and residents have difficulty acquiring procedural competency in these critical procedures. The authors developed objective written, computer, and animal-model assessments of thoracotomy procedural competency to permit comparison of the reliability and validity of these three procedural assessment modalities. ⋯ This study demonstrates that critical emergency medicine procedures can be evaluated reliably and validly using computer simulation and animal-model assessments. Neither previous thoracotomy experience nor knowledge of procedure content adequately predicts thoracotomy competency.
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To associate the efficacy of topical anesthesia of a tetracaine-adrenaline-cocaine solution (TAC) with the duration of skin contact. ⋯ TAC is most effective as a topical anesthetic when applied for more than 20 minutes prior to suturing.
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To determine the availability and relative use of pediatric analgesia and sedation at sites of U.S. emergency medicine residency training programs. ⋯ Emergency medicine residencies generally have available agents for pain control and conscious sedation in children, although the agents used vary widely. Appropriate instruction by trained faculty should enhance resident experience with pediatric pain control and sedation.
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This case series illustrates the use of a suction catheter to guide the passage of an endotracheal (ET) tube through the glottis, a technique modification which can be used when standard nasotracheal intubation is unsuccessful. The technique is appropriate for patients in whom airway management is urgent, but not emergent. Catheter-assisted nasotracheal intubation is useful when intubation is difficult because of excessive patient resistance to movement of the ET tube within the oropharynx. The clinical use of this technique is described for the following scenarios: overdose with obtundation, multiple trauma with agitation, and respiratory failure from pneumonia and pulmonary edema.