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Purpose: The primary objective of this study was to compare Emergency Medical Technicians-Paramedics (EMT-P) perceptions of the usefulness of an automatic transport ventilator (ATV) compared with bag valve (BV) ventilation [...]

Objectives: We sought to evaluate whether there is a sex difference in the analgesic response to µ versus κ opioids in the management of acute moderate to severe pain of [...]

Background: Little has been written about the utility of thoracic electrical bioimpedance (TEB)-derived cardiac physiologic variables in evaluating patients with low-risk chest pain syndromes. Noninvasive bioimpedance can monitor cardiac physiology [...]

Background: Patient comfort is an important part of laceration repair. Methods: The study was a randomized single-blind cross-over trial in which each participant received 250 ml warmed and 250 ml [...]

ABSTRACT Background. A survey study was done to determine basic knowledge about and use of over-the-counter (OTC) pain medications among patients seen in our emergency department (ED). The hypothesis was [...]

Background. The Americans With Disabilities Act (ADA) has been in effect since 1990. The present study shows response to this act for emergency medicine (EM) residents nationwide. Methods. A total [...]

Byline: Amy A Ernst, Kevin M Takakuwa, Craig Letner, Steven J Weiss Abstract: Study objective: To test the hypothesis that ear irrigation with warmed normal saline solution is more comfortable and results in fewer side effects than irrigation with room temperature saline solution in normal volunteers. Methods: The study was a randomized, single-blind, crossover trial in which each subject received 30 mL warmed normal saline solution in 1 ear and 30 mL room temperature saline solution in the opposite ear. The solutions (warmed versus room temperature) and the order of irrigation (right versus left ear) were separately randomized. Investigators obtaining scores were blinded to solution temperature. Subjects rated the discomfort of irrigation, using separate visual analog scales, from 0 (no pain) to 100 mm (worst pain ever). Results: Forty volunteers were enrolled in the study. The mean difference in visual analog scale scores favoring warmed over room temperature saline solution was 26 mm (95% confidence interval [CI], 19 to 33 mm; P Article History: Received 18 December 1998; Revised 4 March 1999; Revised 23 March 1999; Accepted 20 April 1999 Article Note: (footnote) [star] From the University of California Davis Medical Center, Sacramento, CA., [star][star] Address for reprints: Amy A Ernst, MD, UCD Health Center, 2315 Stockton Blvd, Suite 2100 PSSB, Sacramento, CA 95817., a 0196-0644/99/$8.00 + 0 , aa 47/1/99542

Byline: Amy A Ernst, Thomas Thomson, MaryLou Haynes, Steven J Weiss Abstract: Study objective: To test the hypothesis that ocular irrigation with warm saline solution is more comfortable than irrigation with room temperature saline solution in normal volunteers. Methods: The study was a randomized, single-blind crossover trial, in which each subject received 30 mL warmed and 30 mL room temperature saline solution in opposite eyes. The solutions (warmed versus room temperature) and the order of irrigation (right eye versus left) were separately randomized. Physicians were blinded to solution temperature. Subjects rated the discomfort of irrigation on separate visual analog scales (VAS). The study had 80% power to detect at least a 12-mm difference in VAS readings. Results: Thirty-five volunteers were enrolled in the study. There was no gender effect or order effect for the 2 solutions. The mean VAS score for warmed saline solution was 15 mm[+ or -]15 mm (SD). The mean VAS score for room temperature saline was 34 mm[+ or -]24 mm (SD), (95% confidence interval for difference of 19 mm [10 mm to 28 mm], P Article History: Received 9 February 1998; Revised 26 June 1998; Accepted 1 July 1998 Article Note: (footnote) [star] From University of California-Davis Medical Center, Sacramento, CA,* and Vanderbilt University, Nashville, TN.a , [star][star] Address for reprints: Amy A,Ernst, MD, UCD Health Center,Suite 2100 PSSB, Sacramento,CA 95817.Copyright A[c] 1998 by the American College of Emergency Physicians., a 47/1/94233

Byline: Amy A Ernst, Todd G Nick a , Steven J Weiss, Debra HouryAs., Trevor Mills Abstract: Study objective: To determine the prevalence of domestic violence (DV) for male and female ED patients and to determine the demographics of DV. Methods: The study design was a descriptive written survey of adults. We used the Index of Spouse Abuse (ISA), a previously validated survey tool. The study was set in an inner-city ED with approximately 75,000 patients annually, most of them indigent. Patients 18 years or older who were able to give consent were included. Patients were excluded if they had a language barrier, were a prisoner, or had never had a partner. All patients presenting during 31 randomly selected 4-hour shifts during July 1995 were considered for the study. DV was defined as either physical or nonphysical on the basis of ISA scoring. The prevalence was determined for present (in the preceding year) and past (more than 1 year ago) abuse. Four violence parameters were calculated for patients who had a partner at the time of presentation: present physical, present nonphysical, past physical, and past nonphysical. Only the 'past' parameters were calculated for patients who had had a partner in the past but had no partner at the time of presentation. We used the I.sup.2 test to determine individually significant predictors of the four parameters. Logistic-regression models were constructed to determine the significant predictors of DV. Associations among the present physical, present nonphysical, past physical, and past nonphysical abuse categories were determined with McNemar's test. Results: We enrolled 516 patients, 233 men and 283 women. On the basis of ISA scoring, 14% of men and 22% of women had experienced past nonphysical violence (P=.02, men versus women), and 28% of men and 33% of women had experienced past physical violence (P=.35). Of the 157 men and 207 women with partners at the time of presentation, 11% of men and 15% of women reported present nonphysical violence (P=.20), and 20% of men and 19% of women reported physical violence (P=.71). Using logistic-regression models, we determined that women experienced significantly more past and present nonphysical violence but not physical violence than men. For all four parameters, the victim's suicidal ideation and alcohol use were independently associated with DV. The victim's family history was strongly associated with past abuse. Using McNemar's test, we found that physical and nonphysical abuse were correlated in the past and present. Conclusion: Using a validated scale, we found that the prevalences of physical DV for men and women are high and that they are not statistically different in this population. Using I.sup.2 testing, we found that women had experienced significantly more past nonphysical violence than men; using logistic regression we found that they experienced significantly more nonphysical violence (both past and present) than men. DV was frequently associated with suicidal ideation, alcohol use, and family history of violence. [Ernst AA, Nick TG, Weiss SJ, Houry D, Mills T: Domestic violence in an inner-city ED. Ann Emerg Med August 1997;30:190-197.] Article History: Received 26 September 1996; Revised 21 March 1997; Accepted 10 April 1997 Article Note: (footnote) [star] From the Department of Emergency Medicine, Vanderbilt University, Nashville, TN;* the School of Health Related Professions, University of Mississippi Medical Center, Jackson, MS;a and Tulane University School of MedicineAs. and the Section of Emergency Medicine, Louisiana State University,a[yen] New Orleans, LA., [star][star] Reprint no.47/1/83133 , a Address for reprints: Amy A Ernst, MD, Department of Emergency Medicine, Vanderbilt University, 703 Oxford House, Nashville, TN 37232-4700

Surgical cutting, draining, and packing of chancroid buboes may be a preferable treatment over withdrawing the chancroid fluid through a needle. Chancroid is a sexually transmitted bacterial disease that can produce fluid-filled masses called buboes in the genital region. Buboes left untreated can break open and destroy surrounding tissue. Researchers compared the outcome of treating 27 presumed chancroid patients with buboes by either cutting, draining, and packing the mass or withdrawing the fluid through a needle. None of the 12 patients who had their buboes surgically cut, drained, and packed required further treatment. Six of the 15 patients treated with needle draining required repeated treatment. Recovery time was similar for both groups (7-10 days). Only 32% of the patients tested positive for the bacteria causing chancroid.

The high incidence of syphilis among cocaine users indicates that drug histories may be helpful in identifying patients with asymptomatic syphilis. The syphilis epidemic has been linked with the increasing use of crack and resulting changes in sexual behavior in poor, urban areas. Of 102 emergency room patients who admitted to using cocaine, nine were diagnosed with new cases of syphilis and 20 had been previously treated for syphilis. Of the 24 women tested, 58% had new or previously diagnosed syphilis compared with 19% of the men. The eight women who admitted to prostitution had higher rates of new or previously diagnosed syphilis than those who did not. There was no difference in the incidence of syphilis among users who used crack cocaine, injected cocaine or inhaled cocaine. Relying on partner referral to control the syphilis outbreak when people cannot or refuse to name their partners is not effective, so new methods of identifying people with syphilis should be pursued.

The objective of the study was to compare topical lidocaine adrenaline tetracaine (LAT gel) with injectable buffered lidocaine with epinephrine regarding pain of application or injection and anesthesia effectiveness. The study was a randomized prospective comparison trial in an urban emergency department. Physicians and patients ranked the pain of application, injection, and suturing according to a 10-cm visual analog scale. Sixty-six patients were entered, 33 in the LAT gel group and 33 in the injectable buffered lidocaine group. injection was found to be significantly more painful than application of gel (P < 0.001). For anesthesia effectiveness, there was no difference according to patients (P = 0.48) or physicians (P = 0.83) for topical vs injectable forms. The number of sutures causing pain was not statistically different in the two groups (P = 0.28). in conclusion, LAT gel compared favorably with injectable buffered lidocaine for local anesthesia effectiveness and was significantly less painful to apply. it may be the preferred local anesthetic for this reason. (Ernst AA, Marvez-Valls E, Nick TG, Mills T, Minvielle L, Houry D. Topical lidocaine adrenaline tetracaine (LAT gel) versus injectable buffered lidocaine for local anesthesia in laceration repair. West J Med 1997 August; 167:79-81), Anesthetics are known to be painful to inject.[1,2] buffered solutions that adjust the pH of commercially available anesthetic solutions have been shown to decrease the pain of infiltration.[3,4] In a [...]