Abstract:
STUDY OBJECTIVE:We describe and analyze the effectiveness and safety of etomidate for procedural sedation and evaluate the patient's perspective on effectiveness, side effects, and satisfaction. METHODS:We conducted an observational retrospective study of all patients who received etomidate for procedural sedation over 2 years in 3 affiliated suburban emergency departments of a large group-model health maintenance organization. Data were abstracted from the ED records. Additionally, a patient questionnaire was prospectively administered by telephone. RESULTS:Etomidate was used for sedation in 134 patients between 6 and 93 years of age during 150 procedures. The mean cumulative dose was 0.20 mg/kg. Adjunctive medication was used in 36 (23%) procedures. Moderate sedation with verbal arousability was induced in 48 (32%) patients, and deep sedation with verbal unresponsiveness was induced in 102 (68%) patients. Full recovery to the preprocedural level of alertness was achieved within 30 minutes in 142 (95%) of procedures. Mean changes in systolic blood pressure, pulse rate, and oxygen saturation were clinically insignificant. There were 7 (4.7%; 95% confidence interval [CI] 1.9% to 9.4%) adverse events, including 5 (3.3%; 95% CI 1.1% to 7.6%) cases of oxygen desaturation below 94% in older patients (>55 years of age) who received slightly higher mean doses of etomidate (0.23 mg/kg). Four of these patients received brief assisted bag-valve-mask ventilation and recovered uneventfully; none required endotracheal intubation. The questionnaire was completed by 120 (90%) of 134 patients and involved 136 procedures. During 127 (93%) of these, etomidate was believed to be extremely effective in causing sleep, and for 127 (93%) it induced complete procedural amnesia. Only 5 (4%) patients experienced nausea or vomiting. Regarding willingness to receive etomidate for their next procedure, the patients' responses were favorable: extremely, 95%; moderately, 2%; slightly, 3%; and not at all, 1%. CONCLUSION:Etomidate is a useful agent for carefully conducted procedural sedation because it provides effective, brief, deep sedation with little hemodynamic compromise. Its safety may be jeopardized by the occurrence of respiratory depression in older patients receiving higher doses. Patients report a high degree of satisfaction with etomidate.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Vinson DR,Bradbury DRdoi
10.1067/mem.2002.123695subject
Has Abstractpub_date
2002-06-01 00:00:00pages
592-8issue
6eissn
0196-0644issn
1097-6760pii
S0196064402840033journal_volume
39pub_type
杂志文章abstract:STUDY OBJECTIVE:Measurement of interval data is important in the accurate recording of events that occur in an emergency medical services system. Measurement of intervals should be a simple task. However, when two separate clocks are needed to record the beginning and end of an interval, accurate measurement may be dif...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(97)70222-1
更新日期:1997-04-01 00:00:00
abstract:STUDY OBJECTIVE:Anecdotal concerns suggest that health management organization (HMO) membership instructions may deter members from calling 911 or going to an emergency department for a perceived emergency. This study examines such instructions, specifically in regard to their definition of an emergency condition and a...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(99)70267-2
更新日期:1999-07-01 00:00:00
abstract:STUDY OBJECTIVE:This study seeks to examine whether the finding of an abnormal estimated glomerular filtration rate (eGFR) in the emergency department (ED) was associated with acute coronary syndrome in the population of patients presenting for investigation of chest pain. METHODS:We used prospectively collected data ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.annemergmed.2013.01.011
更新日期:2013-07-01 00:00:00
abstract:STUDY OBJECTIVE:We sought to characterize the clinical manifestations, outcome, and etiology of inadvertent ketamine overdose in the emergency department. METHODS:We investigated cases of inadvertent ketamine overdose in children seen in the ED solicited through electronic mail subscription lists or reported to the In...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/s0196-0644(99)80051-1
更新日期:1999-10-01 00:00:00
abstract::A technique of direct mechanical ventricular assistance (DMVA) has been available since 1966. Ventricular assistance is provided by a glass cup lined with a Silastic diaphragm. It is held on the cardiac ventricles by suction. Alternating positive and negative pressure in the space between the cup and the diaphragm pro...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(83)80247-9
更新日期:1983-12-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the interrater reliability of previously defined risk criteria for cervical spine injury. METHODS:Two emergency physicians independently evaluated patients with blunt trauma to determine whether they exhibited any of four risk criteria: (1) altered neurologic function; (2) evidence of into...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(98)70306-3
更新日期:1998-02-01 00:00:00
abstract:STUDY PURPOSE:To determine the ability of clinicians to predict the results of emergency head computed tomography (CT) scans. METHODS:Clinicians requesting cranial CT scans from the emergency department prospectively filled out a form detailing their patients' complaints, possible diagnoses, and the likelihood of find...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(94)70351-5
更新日期:1994-06-01 00:00:00
abstract:STUDY OBJECTIVE:We compare the ability of 5 established risk scores to identify patients with suspected acute coronary syndromes who are suitable for discharge after a modified single-presentation high-sensitivity troponin result. METHODS:This was a prospective observational study conducted in a UK district general ho...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2015.07.006
更新日期:2015-12-01 00:00:00
abstract::A 39-year-old woman presented to the emergency department with symptoms of acute knifelike chest pain and was discharged with a diagnosis of musculoskeletal pain syndrome. One day later, she returned with a complaint of persistent chest pain. Physical examination disclosed meningismus, this led to a lumbar puncture an...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(88)80682-6
更新日期:1988-09-01 00:00:00
abstract::Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), is a propionic acid derivative that possesses analgesic and antipyretic properties through inhibition of prostaglandin synthesis. The propionic acids have been considered the least toxic of the NSAIDs, and one, ibuprofen, is currently available as an over-the-co...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80939-4
更新日期:1989-10-01 00:00:00
abstract::Methemoglobinemia must be considered in the differential diagnosis of the cyanotic patient. Methemoglobin cannot carry oxygen or carbon dioxide. Methemoglobinemia can result from exposure to a wide variety of chemicals, including many commonly prescribed drugs, usually in an overdose situation. Most cases require only...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(82)80502-7
更新日期:1982-04-01 00:00:00
abstract:STUDY OBJECTIVES:The syndrome of rhabdomyolysis associated with cocaine use has been recently described, but the incidence, severity, risk factors, and complications are unknown. This study sought to describe the spectrum of the syndrome and identify clinical features of patients at risk. DESIGN:Retrospective case ser...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81518-5
更新日期:1990-10-01 00:00:00
abstract:STUDY OBJECTIVE:To identify the arterial and mixed venous blood gas changes caused by different ventilatory strategies during resuscitation from ventricular fibrillation in a pig model of closed-chest cardiac compression. METHODS:A prospective randomized animal study was performed using 27 domestic pigs (body weight, ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(98)70203-3
更新日期:1998-05-01 00:00:00
abstract::Three children who presented with localized vesicular rash in the diaper area were found to have primary varicella-zoster infections. Primary varicella can closely mimic genital herpes simplex virus (HSV 1 or 2), which may be an indicator of sexual abuse. To avoid unfounded investigation for sexual abuse, primary vari...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(95)70365-9
更新日期:1995-01-01 00:00:00
abstract::Communication at discharge is an important part of high-quality emergency department (ED) care. This review describes the existing literature on patient understanding and implementation of discharge instructions, discusses previous interventions aimed at improving the discharge process, and recommends best practices a...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/j.annemergmed.2011.10.023
更新日期:2012-08-01 00:00:00
abstract:STUDY OBJECTIVE:We examine whether a specific educational effort reduces emergency department violence in the short term and quantify the amount of violence in the ED. METHODS:Cross-sectional prospective surveys were conducted at a tertiary referral center at baseline (1998) and at 3 and 6 months (1999) after the Prev...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2002.121202
更新日期:2002-01-01 00:00:00
abstract::A case is presented of a vaginal foreign body. A drinking glass was inserted in the vagina of an intoxicated patient by her irate lover. Infection followed. The emergency care is described, including the method of extraction of the object, along with discussion of the principles involved and associated complications. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(81)80287-9
更新日期:1981-09-01 00:00:00
abstract:STUDY OBJECTIVE:Video imaging of intubation as seen by the laryngoscopist has not been a part of traditional instruction methods, and its potential impact on novice intubation success rates has not been evaluated. METHODS:We prospectively tracked the success rates of novice intubators in paramedic classes who were req...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2001.111516
更新日期:2001-01-01 00:00:00
abstract::The American College of Emergency Physicians algorithm project was a pilot study designed to identify a method for evaluating algorithms by peer review and field test. The intent of the pilot project was to make recommendations which would permit a more extensive evaluation of the logic, usefulness, and safety of vari...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(80)80195-8
更新日期:1980-10-01 00:00:00
abstract:STUDY OBJECTIVES:To demonstrate the degree to which pulse oximetry overestimates actual oxyhemoglobin (O2Hb) saturation in patients with carbon monoxide (CO) poisoning. This phenomenon has been reported in fewer than 20 humans in the English medical literature. METHODS:A retrospective chart review of 191 patients eval...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(97)70077-5
更新日期:1997-11-01 00:00:00
abstract::Survival after out-of-hospital cardiac arrest is intimately related to the time from cardiovascular collapse to the initiation of CPR, or downtime. Furthermore, the reperfusion technique that optimizes coronary and cerebral blood flow after cardiac arrest may also be dependent on downtime. Peak blood lactate levels ha...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(87)80408-0
更新日期:1987-12-01 00:00:00
abstract:STUDY OBJECTIVE:We identify measures of emergency department (ED) and hospital workflow that would be of value in understanding, monitoring, and managing crowding. METHODS:A national group of 74 experts developed 113 potential measures using a conceptual model of ED crowding that segmented the measures into input, thr...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/S0196064403008163
更新日期:2003-12-01 00:00:00
abstract::Recent animal and clinical data require a reevaluation of the traditional approach to the patient exposed to carbon monoxide. Unfortunately, these new data are inconclusive and generate controversies regarding the indications and value of neuropsychologic testing, cause of carbon monoxide toxicity, and indications (if...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(94)70136-9
更新日期:1994-08-01 00:00:00
abstract::We report the cases of three patients with residual symptoms from diving decompression sickness, each of whom presented to a recompression chamber three to seven days following original exposure. All three had complete resolution of symptomatology despite the delayed treatment. The late resolution of symptoms is evide...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(85)80450-9
更新日期:1985-03-01 00:00:00
abstract::A prospective study was conducted to determine the usefulness of clinical findings and 25-degree pronation and supination radiologic views to diagnose carpal navicular fractures. All patients presenting to the emergency department during a two-year period who fell on their outstretched hand and had pain and/or swellin...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82039-6
更新日期:1990-03-01 00:00:00
abstract::In an effort to assess the reliability of patient history in excluding pregnancy, we studied the correlation between specific historical factors and the presence of a positive qualitative serum beta-human chorionic gonadotropin assay. Two hundred eight patients were studied, and information was collected prospectively...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80310-5
更新日期:1989-01-01 00:00:00
abstract::Gastrointestinal decontamination has been practiced for hundreds of years; however, only in the past few years have data emerged that demonstrate a clinical benefit in some patients. Because most potentially toxic ingestions involve agents that are not toxic in the quantity consumed, the exact circumstances in which d...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1067/mem.2002.122058
更新日期:2002-03-01 00:00:00
abstract:STUDY OBJECTIVE:We sought to develop and validate standardized clinical criteria to identify patients presenting to the emergency department whose care may be safely deferred to a later date in a nonemergency setting. METHODS:Using a modified Delphi process, a 17-member multidisciplinary physician panel developed expl...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2000.107003
更新日期:2000-07-01 00:00:00
abstract:STUDY OBJECTIVE:To test the hypothesis that residency-trained emergency physicians who left the practice of emergency medicine do not differ significantly from those who continue to practice. DESIGN:A retrospective cohort study using a mailed questionnaire. TYPE OF PARTICIPANTS:Eight hundred fifty-eight emergency med...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)80890-x
更新日期:1992-03-01 00:00:00
abstract::As we mark the 25th anniversary of the clinical application of closed-chest cardiopulmonary resuscitation (SCPR), it is time to look back and analyze the progress we have made in the resuscitation of sudden death syndrome. Recent studies of SCPR's effectiveness have yielded mixed results, in comparison to early studie...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(85)80052-4
更新日期:1985-08-01 00:00:00