Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Observational Study
The Association Between Pretest Probability of Coronary Artery Disease and Stress Test Utilization and Outcomes in a Chest Pain Observation Unit.
Cardiology consensus guidelines recommend use of the Diamond and Forrester (D&F) score to augment the decision to pursue stress testing. However, recent work has reported no association between pretest probability of coronary artery disease (CAD) as measured by D&F and physician discretion in stress test utilization for inpatients. The author hypothesized that D&F pretest probability would predict the likelihood of acute coronary syndrome (ACS) and a positive stress test and that there would be limited yield to diagnostic testing of patients categorized as low pretest probability by D&F score who are admitted to a chest pain observation unit (CPU). ⋯ Physician discretionary decision-making regarding stress test use is associated with pretest probability of CAD. However, based on the D&F score, low-pretest-probability patients who meet CPU admission criteria are very unlikely to have a true-positive stress test or eventually receive a diagnosis of ACS, such that observation and stress test utilization may be obviated.
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The purpose of developing a core content for subspecialty training in clinical ultrasonography (US) is to standardize the education and qualifications required to provide oversight of US training, clinical use, and administration to improve patient care. This core content would be mastered by a fellow as a separate and unique postgraduate training, beyond that obtained during an emergency medicine (EM) residency or during medical school. ⋯ Additionally, it is intended to inform fellowship directors and candidates for certification of the full range of content that might appear in future examinations. This article describes the development of the core content and presents the core content in its entirety.
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Randomized Controlled Trial
Topical Tetracaine Used for 24 Hours Is Safe and Rated Highly Effective by Patients for the Treatment of Pain Caused by Corneal Abrasions: A Double-blind, Randomized Clinical Trial.
The objective of this study was to test the hypothesis that topical tetracaine would be safe to use for 24 hours and would not affect corneal healing, that patients would experience more pain relief, and that patients would perceive tetracaine to be more effective than saline eye drops for the treatment of pain caused by corneal abrasions. ⋯ Topical tetracaine used for 24 hours is safe, and while there was no significant difference in patient VAS pain ratings over time, patient surveys on overall effectiveness showed that patients perceived tetracaine to be significantly more effective than saline.
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The objective was to compare the first-pass success and clinical performance characteristics of the reusable standard GlideScope® video laryngoscope (sGVL) and the disposable Cobalt GlideScope® video laryngoscope (cGVL). ⋯ In this observational study, the sGVL had higher first pass and overall success than the disposable cGVL. The cGVL had significantly higher incidence of lens fogging and contamination, which may partially account for its lower success. A prospective randomized trial is needed to confirm these findings.
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The objective was to survey practicing emergency physicians (EPs) across the United States regarding the frequency of using ultrasound (US) guidance in central venous catheter (CVC) placement and, secondarily, to determine factors associated with the use or barriers to the use of US guidance. ⋯ Among EPs, the translation of evidence to clinical practice regarding the benefits of US guidance for CVC placement is poor and still faces many barriers. Training and education are potentially the best ways to overcome such barriers.