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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As emergency medicine faculty, we are called upon to be skilled in a great number of different areas. Residency training prepares us to be knowledgeable clinicians, skillful at procedures, good communicators, and effective at multitasking. Rarely, however, does it prepare us as educators or in the nuances of career advancement in an academic environment. ⋯ In addition, we all hope to have successful careers as clinician-educators. The goal of this report is 2-fold: to provide a guide for faculty to advance their skills as educators and to help teaching faculty to advance their academic career. The first section of this report presents an approach to becoming a skilled educator, and the second section focuses on career development as an educator in an academic setting.
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Inclusion of a measure of comorbidity in trauma scoring has been suggested due to the potential for preexisting conditions to impact on patient outcomes, but studies have reported varied results. The Charlson Comorbidity Index (CCI) includes 19 diseases weighted on the basis of their association with mortality, and can be extrapolated from International Classification of Diseases, Ninth Revision (ICD-9) codes for administrative databases. ⋯ While the CCI can be extrapolated from ICD codes and provides a measure of comorbid condition severity and was associated with mortality, addition of the CCI to prediction models did not result in a substantial improvement in performance.
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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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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.