Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial Clinical Trial
Bladder ultrasound increases catheterization success in pediatric patients.
To determine whether volumetric bladder ultrasound (VBUS) determinations improve the rate of successful pediatric catheterizations and caregiver satisfaction. ⋯ Although there was no significant difference in caregiver satisfaction between the VBUS and CC groups, implementation of VBUS greatly improved the success rates of pediatric emergency department catheterizations. This improvement is achieved with a rapid and easily mastered VBUS technique.
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Despite numerous advances in medicine, sepsis remains an unconquered challenge. Although outcomes have improved slightly over decades, the unacceptably high mortality rate of 30%-50% for severe sepsis and septic shock continues. However, after years of unsuccessful clinical trials, several investigations over the last few years have reported survival benefit in the treatment of sepsis. ⋯ Clinicians must change the approach to this disease, as well as the way the septic patient is viewed. Although complex and challenging, these therapies must be brought to the patient's bedside. We propose and describe the Multiple Urgent Sepsis Therapies (MUST) protocol as a practical way to implement a comprehensive treatment plan using available evidence-based therapies.
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There are numerous resources available to help educators of medical students improve their methods of instruction. For example, several Internet sites exist that describe specific ways to teach and reinforce concepts basic to emergency medicine. ⋯ Educators may wish to take advantage of distance learning programs that offer instruction in areas such as adult learning, curriculum and teaching methods, and medical education evaluation and research. Finally, educators may wish to participate in professional development opportunities such as fellowships and online modules that have been designed to offer instruction on teaching skills, provide an arena for exchange of effective techniques, and acclimate faculty to academic medicine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of oxycodone and hydrocodone for the treatment of acute pain associated with fractures: a double-blind, randomized, controlled trial.
Previous studies have demonstrated the efficacy of oxycodone and hydrocodone for the treatment of acute pain. However, to the best of the authors' knowledge, no previous reports have compared the efficacies of these commonly prescribed agents. ⋯ Treatment with acetaminophen and either oxycodone, 5 mg po, or hydrocodone, 5 mg po, resulted in pain relief among ED patients with acute fractures, and there was no difference between the two agents at 30 and 60 minutes. Adverse effect profiles were similar, with the exception of a higher incidence of subsequent constipation with the use of hydrocodone. These results suggest that oxycodone and hydrocodone have similarly potent analgesic effects in the first hour of treatment for ED patients with acute fractures.
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Randomized Controlled Trial Clinical Trial
Ultrasound with topical anesthetic rapidly decreases pain of intravenous cannulation.
Physicians and nurses in the emergency department rarely use topical anesthesia when starting intravenous (IV) lines because of time constraints and lack of data on patients' perception of the pain associated with this procedure. Ultrasound pretreatment of skin increases permeation rates of hydrophobic topical medications, including topical lidocaine. The objective of this study was to demonstrate that ultrasound treatment followed by brief application of topical anesthetic decreases the patients' perception of the pain of IV cannulation. ⋯ The SonoPrep ultrasound device applied to skin for 15 seconds followed by 5 minutes of 4% liposomal lidocaine cream significantly reduced patients' perception of the pain of an IV start when compared with standard care. There were no adverse side effects noted in any participant during the 36 hours of the follow-up period.