Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial Multicenter Study
Safety and efficacy of bivalirudin in high-risk patients admitted through the emergency department.
The objective was to assess the safety and efficacy of bivalirudin monotherapy in patients with high-risk acute coronary syndrome (ACS) presenting to the emergency department (ED). ⋯ Bivalirudin monotherapy decreases major bleeding while providing similar protection from ischemic events compared to heparin plus GPI in patients with high-risk ACS admitted through the ED.
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Sudden deaths proximate to use of conducted electrical weapons (CEWs) have been attributed to cardiac electrical stimulation. The rhythm in death caused by rapid, cardiac electrical stimulation usually is ventricular fibrillation (VF); electrical stimulation has not been reported to cause asystole or pulseless electrical activity (PEA). The authors studied the presenting rhythms in sudden deaths temporally proximate to use of TASER CEWs to estimate the likelihood that these deaths could be caused by cardiac electrical stimulation. ⋯ In sudden deaths proximate to CEW discharge, immediate collapse is unusual, and VF is an uncommon VF presenting rhythm. Within study limitations, including selection bias and the possibility that VF terminated before the presenting rhythm was recorded, these data do not support electrically induced VF as a common mechanism of these sudden deaths.
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Randomized Controlled Trial Comparative Study
Ibuprofen provides analgesia equivalent to acetaminophen-codeine in the treatment of acute pain in children with extremity injuries: a randomized clinical trial.
This study compared the analgesic effectiveness of acetaminophen-codeine with that of ibuprofen for children with acute traumatic extremity pain, with the hypothesis that the two medications would demonstrate equivalent reduction in pain scores in an emergency department (ED) setting. ⋯ This study found similar performance of acetaminophen-codeine and ibuprofen in analgesic effectiveness among ED patients aged 5-17 years with acute traumatic extremity pain. Both drugs provided measurable analgesia. Patients tolerated them well, with few treatment failures and minimal adverse effects.
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Patients with bacteremia have a high mortality and generally require urgent treatment. The authors conducted a study to describe bacteremic patients in emergency departments (EDs) and to identify risk factors for mortality. ⋯ Bacteremic patients in the ED have a high mortality, particularly with these risk factors. It is important for physicians to recognize the factors that potentially contribute to mortality of bacteremic patients in the ED.
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Incidents of sudden death following TASER exposure are poorly studied, and substantive links between TASER exposure and sudden death are minimal. The authors studied the effects of a single TASER exposure on markers of physiologic stress in humans. ⋯ A 5-second exposure of a TASER following vigorous exercise to healthy law enforcement personnel does not result in clinically significant changes in ventilatory or blood parameters of physiologic stress.