Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Comparative Study
Confirmation of endotracheal tube placement after intubation using the ultrasound sliding lung sign.
To evaluate the performance of the ultrasound (US) sliding lung sign as a predictor of endotracheal tube (ETT) placement. Many other tools and examination findings have been used to confirm ETT placement; erroneous placement of the ETT has even been confirmed by US. ⋯ These results show that US imaging of the sliding lung sign in a cadaver model is an accurate method for confirmation of ETT placement. Further, the technique may have some utility in differentiating RMS bronchus from main tracheal intubations.
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Medical knowledge is one of six core competencies identified by the Accreditation Council for Graduate Medical Education. The authors present a tool for assessment of medical knowledge developed by the Council of Emergency Medicine Residency Directors. ⋯ The result is a collaborative specialty-wide approach to the common problem of formatting tests to assess medical knowledge. The tool has been widely accepted by both residents and residencies.
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Randomized Controlled Trial Comparative Study
The decision to use topical anesthetic for intravenous insertion in the pediatric emergency department.
Topical anesthetic creams to reduce the pain of intravenous (IV) placement may be more effectively used in the emergency setting if they are applied by nurses in the triage area of the emergency department or soon after the patient is placed into a room. This strategy requires accurate prediction of which patients will require IV placement. The objective of this study was to compare triage nurse judgment regarding IV placement in pediatric patients with a triage prediction rule using chief complaint, referral status, and high-risk medical history. A secondary objective was to evaluate whether the presence of the anesthetic cream placed in triage influenced the subsequent decision to place an IV and thus invalidate the prediction strategy. ⋯ Triage nurse judgment to predict eventual IV placement had greater sensitivity and similar predictive value compared with a prediction model based on medical history and chief complaint. The triage placement of topical anesthetic in pediatric patients did not change the eventual rate of IV placement.
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Randomized Controlled Trial Comparative Study
Randomized controlled trial of single-operator vs. two-operator ultrasound guidance for internal jugular central venous cannulation.
Use of ultrasound guidance for central line placement generally requires two operators: one to hold the transducer and the other to guide the needle. The authors propose a single-operator technique and compare it with the two-operator technique for placement of internal jugular central lines. ⋯ This one-person technique appears to be equivalent to the standard two-person technique for successful ultrasound-guided internal jugular central venous catheterization with respect to overall success.
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Comparative Study
The validity of using multiple imputation for missing out-of-hospital data in a state trauma registry.
To assess 1) the agreement of multiply imputed out-of-hospital values previously missing in a state trauma registry compared with known ambulance values and 2) the potential impact of using multiple imputation versus a commonly used method for handling missing data (i.e., complete case analysis) in a typical multivariable injury analysis. ⋯ Multiply imputed out-of-hospital values for intubation attempt, Glasgow Coma Scale score, systolic blood pressure, and respiratory rate have fair to good agreement with known ambulance values. Multiple imputation also increased precision and reduced bias compared with complete case analysis in a typical multivariable injury model, and it should be considered for studies using out-of-hospital data from a trauma registry, particularly when substantial portions of data are missing.