J Emerg Med
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In the past decade, México, with the third largest population of any country in the Americas, has experienced rapid growth in Emergency Medicine education. Emergency Medicine residency programs began in México City in 1986 and in 1991, spread throughout the country when the Medical Institute of Social Services (IMSS) instituted programs at their specialty hospitals. Although pre-hospital care is still rudimentary in many parts of the country and there are insufficient numbers of trained emergency physicians to staff the nation's Emergency Departments, the growth of the specialty is helping to improve the quality of medical care in México. This article discusses the current condition of and prospects for Emergency Medicine in México within the context of its medical system, and outlines objectives and guidelines for future developments.
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Randomized Controlled Trial
A randomized, clinical trial comparing the efficacy of continuous nebulized albuterol (15 mg) versus continuous nebulized albuterol (15 mg) plus ipratropium bromide (2 mg) for the treatment of acute asthma.
Multiple studies have examined adding nebulized ipratropium bromide to intermittent albuterol for the treatment of acute asthma. Although continuous nebulized treatments in themselves offer benefits; few data exist regarding the efficacy of adding ipratropium bromide to a continuous nebulized system. To compare continuous nebulized albuterol alone (A) vs. albuterol and ipratropium bromide (AI) in adult Emergency Department (ED) patients with acute asthma, a prospective, randomized, double-blind, controlled clinical trial was conducted on a convenience sample of patients (IRB approved). ⋯ Mean improvement in PEFR at 60 min compared to baseline (time 0): (A) = 93.2 L/min (95% confidence interval [CI] 64.5-121.8), (AI) = 86.6 L/min (95% CI 58.9-114.3); mean improvement in PEFR at 120 min compared to baseline (time 0) (A) = 116.5 L/min (95% CI 84.5-148.5), (AI) = 126.4 L/min (95% CI 95.4-157.4). There was no statistically significant difference in admission rates between groups: 5/30 (A) and 8/32 (AI) (p = 0.62). There were no significant differences in mean improvement of PEFR at either 60 or 120 min between ED patients with acute asthma receiving continuous albuterol alone vs. those receiving albuterol in combination with ipratropium bromide.
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Randomized Controlled Trial
Parenteral corticosteroids for Emergency Department patients with non-radicular low back pain.
Although not recommended for low back pain, the efficacy of systemic corticosteroids has never been evaluated in a general low back pain population. To test the efficacy of systemic corticosteroids for Emergency Department (ED) patients with low back pain, a randomized, double-blind, placebo-controlled trial of long-acting methylprednisolone was conducted with follow-up assessment 1 month after ED discharge. Patients with non-traumatic low back pain were included if their straight leg raise test was negative. ⋯ The change in NRS between discharge and 1 month differed between the two groups by 0.6 (95% confidence interval -1.0 to 2.2), a clinically and statistically insignificant difference. Disability, medication use, and healthcare resources utilized were comparable in both groups. Corticosteroids do not seem to benefit patients with acute non-radicular low back pain.
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Fractures of the thoracic and lumbar vertebrae as a direct consequence of generalized epileptic convulsions are the most common non-traumatic type of fracture complicating epileptic seizures. The majority of these fractures are compression fractures that occur with minimal symptoms and virtually no permanent neurological sequela. ⋯ The aim of this report is to draw attention to this serious complication of generalized convulsive seizures and alert readers to epilepsy-related vertebral fractures. Diagnosis and management of acute cauda equina-conus medullaris syndrome caused by lumbar fracture are reviewed.
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Emergency nurses (ENs) typically place peripheral intravenous (IV) lines, but if repeated attempts fail, patients usually receive central line access. To measure the effect of ultrasound (US) guidance on the perceived difficulty of EN peripheral IV access in Emergency Department patients, a prospective observational study was conducted of ENs in a level I trauma center with a census of 75,000, performing US-guided IV line placement in difficult stick patients (difficult or hard stick patients defined as repeated blind IV placement failure or established history of blind IV placement failure). ENs trained on an inanimate model after a 45-min lecture. ⋯ There were 258 (80%) of the patients rated as very hard sticks before US, 59 as hard, 3 as easy, and none as very easy. Of the 258 very hard sticks without US, 29 were still rated as very hard even with US use; 43 changed to hard, 112 changed to easy and 137 to very easy. After a brief tutorial, ultrasound guidance for IV access in emergency patients significantly decreased the perceived difficulty in difficult access patients.