Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial Comparative Study
Randomized clinical trial of nebulized fentanyl citrate versus i.v. fentanyl citrate in children presenting to the emergency department with acute pain.
To compare the pain relief achieved with nebulized fentanyl citrate with intravenous (i.v.) fentanyl citrate in children presenting to the emergency department (ED) with painful conditions to determine if nebulized fentanyl is a feasible alternative to i.v. fentanyl for the treatment of acute pain in children. ⋯ Nebulized fentanyl citrate 3 microg/kg through a breath-actuated nebulizer appears to be a feasible alternative to i.v. fentanyl citrate for a variety of painful conditions in patients older than 3 years.
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Comparative Study
Reliability of a computerized version of the Pediatric Canadian Triage and Acuity Scale.
The use of a standardized triage tool allows better comparison of the patients; a computerized version could theoretically improve its reliability. ⋯ A computerized version of the PedCTAS showed a statistically significant improvement in the interrater agreement for nurses evaluating the triage level of 54 clinical scenarios, but this difference has probably small clinical significance.
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The reality of emergency health care in the United States today requires new approaches to mental health in the emergency department (ED). Major depression is a disabling condition that disproportionately affects women. ⋯ ED providers rarely addressed depression. Qualitative analysis of significant patient-provider interactions regarding depression found that screening for depression in the ED can be accomplished with minimal expenditure of provider time and effort. Attention to psychosocial risk factors has the potential to improve the quality of ED care and patient satisfaction.
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Randomized Controlled Trial
Adding long-acting beta-agonists to inhaled corticosteroids after discharge from the emergency department for acute asthma: a randomized controlled trial.
Relapses of asthma following emergency department discharge can be reduced with oral and inhaled corticosteroids (ICSs), but the benefits of long-acting beta-agonists (LABAs) are unclear. ⋯ Outpatient treatment with a short course of systemic corticosteroids combined with ICSs is adequate for most patients with asthma discharged from the emergency department; those already receiving ICS agents may benefit from ICS/LABA combination therapy to improve quality of life. Larger studies are needed to confirm the role of inhaled LABAs in acute asthma.