Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Comparative Study
Evaluation of hemoperitoneum using a single- vs multiple-view ultrasonographic examination.
To compare the sensitivities, specificities, and accuracies between a single-view ultrasonography (US) technique and a multiple-view technique for identifying hemoperitoneum in multiple-trauma patients. ⋯ An initial trauma US examination using a multiple-view technique is more sensitive than that using a single-view technique for detecting hemoperitoneum in trauma patients.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Intravenous chlorpromazine vs intravenous metoclopramide in acute migraine headache.
To compare the efficacy of IV chlorpromazine with that of IV metoclopramide in the treatment for acute migraine headache in the ED. ⋯ Metoclopramide and chlorpromazine administered IV are both effective in the management of acute migraine headache. They are associated with similar minor side-effect profiles.
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Meta Analysis
Ultrasonography to evaluate adults for appendicitis: decision making based on meta-analysis and probabilistic reasoning.
To review ultrasonography (US) test performance and to develop recommendations for the use of US to aid in the evaluation of potential appendicitis. ⋯ 1) US should not be used to exclude appendicitis for patients who have "classic" signs/symptoms, due to the underlying high false-negative rate. 2) US is most useful for patients who have an indeterminate probability of disease after the initial evaluation--if US is positive, the patient should have an operation; otherwise, he or she should be observed. 3) US is not recommended for screening patients who have a low probability of appendicitis, due to the low prevalence of disease and high false-positive rate in this group.
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The issue of whether a traumatic but occult cervical spine fracture can exist has generated significant debate in emergency medicine. The profound clinical and legal implications of missing an unstable cervical spine injury are well known to the emergency care provider. ⋯ The patient experienced delayed subluxation of her acute odontoid fracture during a flexion/extension examination completed in the ED, with resultant development of cervical discomfort. Elderly victims of trauma with an appropriate mechanism of injury should be suspected of subtle or occult neck injuries.
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Comparative Study
Effect of continuous quality improvement methods on reducing triage to thrombolytic interval for acute myocardial infarction.
To assess the timeliness of thrombolytic therapy in the ED for selected patients with acute myocardial infarction (AMI) following continuous quality improvement (CQI) interventions. ⋯ The implementation of CQI techniques, including 100% chart review, intensive systems analysis, and staff feedback, had a positive effect on the timeliness of thrombolytic therapy for the ED patients who had AMI. As a result, most (79%) of the patients received therapy within the 60-minute time window recommended currently by the American Heart Association.