J Emerg Med
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The number of colonoscopies performed in the United States is increasing each year. Although the procedure is generally safe and effective, complications can arise. Splenic laceration is an extremely rare complication of colonoscopy. ⋯ A 71-year-old woman presented to the Emergency Department with abdominal pain and left shoulder pain accompanied by nausea within 24 h of undergoing a colonoscopy. A computed tomography scan showed hemoperitoneum, with findings suggestive of a splenic laceration. Upon laparoscopy, the patient was found to have a splenic laceration with active bleeding. She was treated with splenectomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Colonoscopy is one of the most commonly performed outpatient procedures in the United States. As such, being able to recognize potential complications of the procedure is essential. With the number of colonoscopies being performed each year increasing, the emergency physician should be aware of the remote possibility of splenic injury as a cause of abdominal pain whenever a history of recent colonoscopy is elicited from the patient.
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Animals and humans can be readily conditioned to associate a novel stimulus (often a unique taste) by pairing it with the effects of a drug or other agent. When later presented with the stimulus alone, their body's systems respond as if the drug or agent were given. The earliest clinical applications demonstrated both conditioned suppression and enhancement of immune processes. ⋯ The purpose of this analysis was to stimulate research in, and the application of, placebo-response conditioning to emergency medicine. Clinical and experimental studies confirm the usefulness of conditioned placebos in analgesia and in placebo-controlled dose reduction. Such conditioning paradigms demonstrate "one-trial learning," making them potentially useful in pain and addiction management within a single emergency department encounter.
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Meta Analysis
Endotracheal Tube Placement Confirmation by Ultrasonography: A Systematic Review and Meta-Analysis of more than 2500 Patients.
The integration of point-of-care ultrasound in endotracheal tube placement confirmation has been focus of many recent studies. ⋯ Ultrasonography is a valuable and reliable adjunct for endotracheal tube confirmation, including during cardiac arrest resuscitation.
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Randomized Controlled Trial
External Cardiac Massage Training of Medical Students: A Randomized Comparison of Two Feedback Methods to Standard Training.
The most recent recommendations support learning of external cardiac massage (ECM) through feedback devices. ⋯ The use of a feedback device used for ECM training improves the quality of immediate retention of technical ECM skills compared with traditional teaching in medical students. At 3 months, the 2 groups with feedback retained a high level of performance. No significant difference could be demonstrated between the 2 feedback methods.
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Viscoelastography (VE) is an established method to identify coagulopathies in various disease processes. Clinical decisions can be made with real-time tracings and quantitative values at the bedside. Thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) have been utilized in several disease states with clinical varying success. ⋯ This review serves as a way for emergency medicine clinicians to utilize VE in their practice and provides an insightful literature overview.