Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
Randomized Controlled Trial Comparative Study Clinical Trial
Randomized double-blind placebo controlled crossover study of acetaminophen, ibuprofen, acetaminophen/hydrocodone, and placebo for the relief of pain from a standard painful stimulus.
The objective was to compare subjects' change in perceived acute pain from an identical painful stimulus after receiving three separate, commonly used pain medications and placebo. ⋯ There was a wide range of changes in pain scores from this identical painful stimulus after receiving the study medications. Acetaminophen and acetaminophen/hydrocodone resulted in a similar decrease in pain (10.2 and 9.5%), while ibuprofen and placebo had a similar lack of effect (-6.6 and -6.9%). Forty-four percent of subjects receiving acetaminophen/hydrocodone reported mild side effects; no other side effects were seen. In this noninflammatory pain model, the VAS is not able to distinguish differences in pain relief between acetaminophen and acetaminophen/hydrocodone or ibuprofen and placebo.
-
Randomized Controlled Trial Comparative Study
Randomized clinical trial of propofol with and without alfentanil for deep procedural sedation in the emergency department.
The objectives were to compare the efficacy, occurrence of adverse events, and recovery duration of propofol with and without alfentanil for use in procedural sedation in the emergency department (ED). ⋯ The use of supplemental alfentanil with propofol for procedural sedation did not result in a difference in reported pain or recall immediately after the procedure. There was an increase in the proportion of patients who required stimulation to induce respiration during the procedure in patients who received propofol with supplemental alfentanil. The addition of supplemental opioid to procedural sedation with propofol does not appear beneficial.
-
The Emergency Severity Index (ESI) triage algorithm is a five-level triage acuity tool used by emergency department (ED) triage nurses to rate patients from Level 1 (most acute) to Level 5 (least acute). ESI has established reliability and validity in an all-age population, but has not been well studied for pediatric triage. This study assessed the reliability and validity of the ESI for pediatric triage at five sites. ⋯ Reliability of the ESI for pediatric triage is moderate. The ESI provides a valid stratification of pediatric patients into five distinct groups. We found several areas in which nurses have difficulty triaging pediatric patients consistently. The study results are being used to develop pediatric-specific ESI educational materials to strengthen reliability and validity for pediatric triage.
-
Factors that affect success on the national paramedic certification examination have been identified. However, there are no known studies that have examined success on the paramedic exam with respect to either Emergency Medical Technician-Basic (EMT-B) examination score or length of EMT-B certification (which may reflect field experience gained prior to enrolling in paramedic training). The objectives of this study included assessing the relationship of EMT-B examination score and length of EMT-B certification to success on the national paramedic certification examination. ⋯ Both EMT-B examination score and ength of EMT-B certification are associated with success on first attempt at the cognitive portion of the national paramedic certification exam. Educators may wish to consider these two factors when determining paramedic program admission standards and/or consider these variables when determining how to allocate program resources.
-
Emergency departments (EDs) in teaching hospitals have competing goals of timely patient care and supervised trainee education. Previous investigations have indicated that trainees add time to the length of ED patient encounters. However, no studies have quantified the effect of trainees on pediatric ED length of stay (LOS). ⋯ In the pediatric ED of a teaching hospital, ED LOS is on average 9% higher in patients seen by trainees. In an era of increasing efforts to accelerate throughput while training future providers, these findings provide an important metric for the delivery of pediatric emergency care.