Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To determine whether patients presenting to the emergency department (ED) with first-trimester pregnancy complications have a decreased length of stay (LOS) when a live intrauterine pregnancy (IUP) is diagnosed by emergency physicians (EPs). ⋯ Emergency physicians identifying live IUP with bedside ultrasonography significantly decreased patients' LOSs in the ED. The decrease in LOS was most apparent for patients presenting during evening and nighttime hours.
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To the authors' knowledge, no outcome-based, randomized clinical trial of the safety of opioid analgesics in acute abdominal pain exists. ⋯ A clinical trial would need to randomize more than 1,500 patients to establish the equivalent adverse outcome rates of opioids and placebo: the sample size of all existing studies combined is insufficient to make such a conclusion. Although opioids were associated with a higher adverse outcome rate in this logistic regression, the authors believe this may be due to confounding by pain severity. They emphasize that the study's design precludes conclusion of a causal link. No change in clinical practice is warranted. A randomized clinical trial of sufficient size to definitively resolve this issue is needed.
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Emergency departments (EDs) provide an opportunity to initiate preventive services for millions of Americans who have no other source for these services. ⋯ A set of recommendations for prevention, screening, and counseling activities in the ED based on systematic reviews of selected interventions is presented. The applicability of these primary and secondary preventive services will vary with the different clinical environments and resources available in EDs. The PHTF recommendations should not be used as the basis of curtailing currently available services. This review makes clear the need for further research in this important area.