Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
Death notification is a common, difficult, and emotionally laden communication for emergency physicians. Teaching emergency medicine residents the skills for success in this communication is an important focus for educators. To accomplish this task, educators need practical, proven teaching and assessment tools focused on death notification skills. ⋯ This study demonstrates that a defined educational intervention focused on the GRIEV_ING mnemonic can improve physician confidence and competence in death notification.
-
To determine whether ancillary tests of cerebrospinal fluid (CSF), specifically, the total protein concentration, glucose concentration, and percent neutrophils, provide information for diagnosing acute bacterial meningitis among children with low white blood cell (WBC) count in CSF. ⋯ When markedly abnormal, results of CSF total protein concentration, glucose concentration, and percent neutrophils have value for diagnosing acute bacterial meningitis, even among children with a low WBC count in CSF.
-
Influenza outbreaks have been associated with worsened emergency department (ED) crowding. We sought to examine the mechanism behind this association. ⋯ Influenza season is associated with increased ED utilization by patients aged 65 years and older, most of whom have major respiratory illnesses and may require hospital admission. No association was seen between influenza and utilization by younger patients. Efforts to reduce the impact of influenza seasons on EDs should focus on elders.
-
To determine the prevalence of hip and pelvic fractures in emergency department (ED) patients with hip pain and negative standard initial radiographs. ⋯ In this cohort of ED patients with symptoms suspicious for hip fracture who had negative standard radiographs, the authors found that 4.4% were subsequently diagnosed as having fracture. Further studies are warranted to identify characteristics of patients requiring advanced hip imaging studies.
-
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.