Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Propofol versus midazolam/fentanyl for reduction of anterior shoulder dislocation.
The authors aimed to compare propofol and midazolam/fentanyl for reduction of anterior shoulder dislocations using the modified Kocher's maneuver. ⋯ Propofol appears to be as effective as midazolam/fentanyl for reduction of anterior shoulder dislocation using the modified Kocher's maneuver. However, the advantage of shorter wakening times associated with propofol should be weighed against the possibility of adverse events, particularly respiratory depression and vomiting.
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Multicenter Study Comparative Study
Attitudes and judgment of emergency physicians in the management of patients with acute headache.
There is little evidence guiding physicians in the evaluation of acute headache to rule out nontraumatic subarachnoid hemorrhage (SAH). The authors assessed emergency physicians in: 1) their pretest accuracy for predicting SAH, 2) their comfort with not ordering either head computed tomography (CT) or lumbar puncture (LP) in patients with acute headache, and 3) their comfort with not ordering head CT before performing LP in patients with acute headache. ⋯ Physicians were able to moderately discriminate SAH from other causes of headache before diagnostic testing.
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Comparative Study
An emergency department guideline for the diagnosis of pulmonary embolism: an outcome study.
To assess the clinical outcome of patients suspected of pulmonary embolism (PE) following implementation of an emergency department (ED) diagnostic guideline. ⋯ Implementation of a PE diagnostic guideline in a community ED setting is safe and has improved the specificity of the enzyme-linked immunosorbent assay D-dimer test when compared with previous studies.
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Urinary tract infections (UTIs) and early pelvic infections due to sexually transmitted disease (STD) may cause similar symptoms. Therefore, a simple history and urine dip to establish a diagnosis of UTI may result in overtreatment of UTIs and undertreatment of STDs. The objective of this study was to determine the proportion of women with symptoms suggestive of a UTI who are urine culture positive versus urine culture negative, the prevalence of STDs between groups, and if elements of the history or examination may predict those requiring STD screening. ⋯ A total of 17.3% of women with symptoms of a UTI in this study had an STD, while only 57.3% were urine culture positive by catheterization using low count criteria. The proportion of STDs between those with and without a UTI was not significantly different.
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Comparative Study
Potential impact of a targeted cardiopulmonary resuscitation program for older adults on survival from private-residence cardiac arrest.
Traditional cardiopulmonary resuscitation (CPR) training programs do not target older adults who are most likely to witness private-residence cardiac arrests and do not reliably result in a bystander who is likely to perform CPR in the event of an arrest. This study was performed to compare targeted CPR training programs for older adults (older than 50 years) that 1) increase numbers of CPR-trained bystanders of private-residence cardiac arrest or 2) increase the percentage of trained bystanders of private-residence cardiac arrest who perform CPR. A simultaneous outcome was to estimate the minimal significant survival benefit associated with each of the training programs. ⋯ CPR training programs that focus on yielding 75% of trainees who perform CPR in the event of witnessing an arrest would have equivalent results to mass CPR training programs that result in 70% of bystanders being trained in CPR. However, the minimal survival benefit associated with these programs (around 0.2%) may prove either method costly with minimal effect.