Abstract:
STUDY OBJECTIVE:We examine the central venous catheter placement rate during the implementation of an ultrasound-guided peripheral intravenous access program. METHODS:We conducted a time-series analysis of the monthly central venous catheter rate among adult emergency department (ED) patients in an academic urban ED between 2006 and 2011. During this period, emergency medicine residents and ED technicians were trained in ultrasound-guided peripheral intravenous access. We calculated the monthly central venous catheter placement rate overall and compared the central venous catheter reduction rate associated with the ultrasound-guided peripheral intravenous access program between noncritically ill patients and patients admitted to critical care. Patients receiving central venous catheters were classified as noncritically ill if admitted to telemetry or medical/surgical floor or discharged home from the ED. RESULTS:During the study period, the ED treated a total of 401,532 patients, of whom 1,583 (0.39%) received a central venous catheter. The central venous catheter rate decreased by 80% between 2006 (0.81%) and 2011 (0.16%). The decrease in the rate was significantly greater among noncritically ill patients (mean for telemetry patients 4.4% per month [95% confidence interval {CI} 3.6% to 5.1%], floor patients 4.8% [95% CI 4.2% to 5.3%], and discharged patients 7.6% [95% CI 6.2% to 9.1%]) than critically ill patients (0.9%; 95% CI 0.6% to 1.2%). The proportion of central venous catheters that were placed in critically ill patients increased from 34% in 2006 to 81% in 2011 because fewer central venous catheterizations were performed in noncritically ill patients. CONCLUSION:The ultrasound-guided peripheral intravenous access program was associated with reductions in central venous catheter placement, particularly in noncritically ill patients. Further research is needed to determine the extent to which such access can replace central venous catheter placement in ED patients with difficult vascular access.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Shokoohi H,Boniface K,McCarthy M,Khedir Al-tiae T,Sattarian M,Ding R,Liu YT,Pourmand A,Schoenfeld E,Scott J,Shesser R,Yadav Kdoi
10.1016/j.annemergmed.2012.09.016subject
Has Abstractpub_date
2013-02-01 00:00:00pages
198-203issue
2eissn
0196-0644issn
1097-6760pii
S0196-0644(12)01549-1journal_volume
61pub_type
杂志文章abstract::During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. Over the cou...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:
更新日期:1998-02-01 00:00:00
abstract:STUDY OBJECTIVE:The literature suggests that the d -dimer is useful in patients suspected of having pulmonary embolism and who have a low pretest probability of disease. A previously defined clinical decision rule, the Wells Criteria, may provide a reliable and reproducible means of determining this pretest probability...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2004.04.002
更新日期:2004-11-01 00:00:00
abstract::Airway compromise is the most common cause of death and severe morbidity in acutely ill and injured children. Rapid-sequence intubation (RSI) is a technique for emergency airway control designed to maximize successful endotracheal intubation while minimizing the adverse physiologic effects of this procedure. RSI requi...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(96)70140-3
更新日期:1996-07-01 00:00:00
abstract:STUDY OBJECTIVE:We determine the cost-effectiveness of out-of-hospital continuous positive airway pressure (CPAP) compared with standard care for adults presenting to emergency medical services with acute respiratory failure. METHODS:We developed an economic model using a United Kingdom health care system perspective ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2014.12.028
更新日期:2015-05-01 00:00:00
abstract::We compared the abilities of the Trauma Score (TS), the Revised Trauma Score (RTS), and the Pediatric Trauma Score (PTS) to retrospectively identify severely injured children. TS, RTS, and PTS were computed on admission for 1,334 consecutive blunt and penetrating trauma victims 0 to 14 years old. Injury Severity Score...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80930-8
更新日期:1989-10-01 00:00:00
abstract:STUDY OBJECTIVES:To confirm the ability of the esophageal detector device (EDD) to indicate positioning of endotracheal tubes (ETTs) in patients intubated under emergency conditions and to compare the performance of the EDD with that of end-tidal carbon dioxide (ETCO2). METHODS:This single-subject study comprising a p...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1016/s0196-0644(96)70162-2
更新日期:1996-05-01 00:00:00
abstract:STUDY OBJECTIVE:We estimate the test characteristics of nasogastric aspiration to diagnose upper gastrointestinal tract hemorrhage in patients without hematemesis. METHODS:In this retrospective cohort study, medical records from patients admitted to 2 urban hospitals between 1997 and 2002 for gastrointestinal tract bl...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2003.09.002
更新日期:2004-04-01 00:00:00
abstract:STUDY OBJECTIVE:The STONE score is a clinical decision rule that classifies patients with suspected nephrolithiasis into low-, moderate-, and high-score groups, with corresponding probabilities of ureteral stone. We evaluate the STONE score in a multi-institutional cohort compared with physician gestalt and hypothesize...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.annemergmed.2015.08.019
更新日期:2016-04-01 00:00:00
abstract:STUDY OBJECTIVE:Glottic visualization with video is superior to direct laryngoscopy in controlled operating room studies. However, glottic exposure with video laryngoscopy has not been evaluated in the emergency department (ED) setting, where blood, secretions, poor patient positioning, and physiologic derangement can ...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1016/j.annemergmed.2010.01.033
更新日期:2010-08-01 00:00:00
abstract::Abruptio placentae is a complication of pregnancy associated with significant morbidity and mortality for both fetus and mother. The presence of uterine pain and tenderness traditionally has been considered a useful criterion for distinguishing abruptio placentae from other causes of bleeding in pregnancy. We report t...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81040-6
更新日期:1992-07-01 00:00:00
abstract:STUDY OBJECTIVE:Radiology-performed transabdominal pelvic ultrasound, used to evaluate female patients with suspected pelvic pathology in the pediatric emergency department (ED), is often delayed by the need to fill the bladder. We seek to determine whether point-of-care ultrasound assessment of bladder fullness can pr...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2018.04.010
更新日期:2018-11-01 00:00:00
abstract::To help establish a rational approach to the initial management of Clinitest tablet ingestion, we investigated the effect of number of tablets, volume of diluent, and type of diluent on dissolution time (TD), temperature generation (delta T), and pH. Dissolution time was independent of the number of tablets and the vo...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(86)80008-7
更新日期:1986-02-01 00:00:00
abstract::Venomous bites and stings are numerous but severe local tissue damage is uncommon. Venoms may be simple substances or complex mixtures of many poorly characterized components whose interactions are still not fully understood. The best studied example of a dermonecrotic venom is that produced by the brown recluse spide...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(88)80360-3
更新日期:1988-12-01 00:00:00
abstract::Glyburide, a second-generation sulfonylurea hypoglycemic agent, is metabolized by the P-450 hepatic enzyme system. Ciprofloxacin, a widely used quinolone antibiotic, is a recognized P-450 enzyme inhibitor. Conflicting data exist in the medical literature on the ability of quinolone antibiotics to inhibit glyburide hep...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2000.108617
更新日期:2000-08-01 00:00:00
abstract::Several clinical studies have yielded conflicting results in examining the effectiveness of bystander CPR (BCPR). The purpose of this pilot study was to determine the effectiveness of BCPR in an animal model of cardiac arrest and resuscitation. Ten swine were instrumented for hemodynamic and regional blood flow measur...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81561-6
更新日期:1990-08-01 00:00:00
abstract:STUDY OBJECTIVE:We assessed the independent relationship between age and the quality of medical care provided to patients presenting to the emergency department (ED) with acute myocardial infarction. METHODS:We conducted a 2-year retrospective cohort study of 2,216 acute myocardial infarction patients presenting urgen...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2004.12.012
更新日期:2005-07-01 00:00:00
abstract::Managed care organizations (MCOs) have proliferated throughout the United States. Interaction by patients, physicians, and emergency medical services systems with MCOs is evolving. Although MCOs have had some notable successes in reducing health care expenditures, the way in which MCO enrollees gain access to emergenc...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(96)70098-7
更新日期:1996-12-01 00:00:00
abstract:STUDY OBJECTIVE:To determine whether physicians blinded to the serum potassium level can predict hyperkalemia (potassium concentration of more than 5.0 mmol/L) from the ECG. DESIGN:ECGs of patients at high risk for hyperkalemia were interpreted retrospectively by two physicians blinded not only to the specific clinica...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81476-3
更新日期:1991-11-01 00:00:00
abstract:STUDY OBJECTIVE:I evaluate the variation in requirements for informed consent in studies evaluating chemical tranquilization of agitated patients. METHODS:A computer-assisted literature search of the National Library of Medicine was performed. Additional use of the references listed in the articles identified with the...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2005.08.025
更新日期:2006-01-01 00:00:00
abstract:STUDY OBJECTIVE:We assess the effectiveness of patient-controlled analgesia in the emergency department (ED). We hypothesized that decline in pain intensity from 30 to 120 minutes after initial intravenous opioid administration is greater in patients receiving morphine by patient-controlled analgesia compared with usua...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2017.03.064
更新日期:2017-12-01 00:00:00
abstract::A 36-year-old man developed extreme shortness of breath after injecting "freebase" cocaine intravenously. Clinical and radiographic evaluation confirmed acute pulmonary edema, and blood gas studies substantiated acute respiratory failure. Despite vigorous therapy, the patient died three hours after admission. When coc...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(81)80314-9
更新日期:1981-08-01 00:00:00
abstract:STUDY OBJECTIVE:To determine whether a one-time dose of triamcinolone diacetate, 40 mg intramuscular (i.m.), given to adult patients treated in the emergency department for mild to moderate exacerbation of asthma would decrease the rate of relapse during the following week, compared with a nontapering course of oral pr...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0196-0644(98)70343-9
更新日期:1998-03-01 00:00:00
abstract::This clinical policy focuses on critical issues concerning the management of patients presenting to the emergency department (ED) with acetaminophen overdose. The subcommittee reviewed the medical literature relevant to the questions posed. The critical questions are: 1. What are the indications for N-acetylcysteine (...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,实务指引
doi:10.1016/j.annemergmed.2007.06.014
更新日期:2007-09-01 00:00:00
abstract:STUDY OBJECTIVE:We characterize the quantity and quality of data tables and figures in reports of randomized controlled trials (RCTs) submitted to the British Medical Journal (BMJ) and published in peer-reviewed journals. We investigate how the peer review process affected table and figure quality. METHODS:We reviewed...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2006.06.017
更新日期:2006-12-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the efficacy of a 4-day "burst" course of prednisone added to standard treatment with H1 antihistamines for the management of acute urticaria in outpatients. DESIGN:Prospective, randomized, double-blinded, clinical trial. SETTING:Emergency department of an urban tertiary care teaching hosp...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0196-0644(95)70002-1
更新日期:1995-11-01 00:00:00
abstract::Epiglottitis in adults, while uncommon, is certainly not rare. Despite the increasing reports of the disorder in the literature, it continues to be misdiagnosed in emergency departments. The first step in the diagnosis of acute epiglottitis is for the emergency physician to think of it. The literature concerning the e...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(81)80463-5
更新日期:1981-01-01 00:00:00
abstract::[Centers for Disease Control and Prevention. Use of pulsed-field gel electrophoresis for investigation of a cluster of invasive group A streptococcal illness-Spokane, Washington, 1999. MMWR Morb Mortal Wkly Rep. 1999;48:681-683.]. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/S0196-0644(00)70088-6
更新日期:2000-03-01 00:00:00
abstract:STUDY OBJECTIVE:We describe current alcohol screening and brief intervention practices in emergency departments (EDs) at Level I and Level II trauma centers and characterize ED directors' attitudes and perceived barriers associated with these practices among injured patients in the ED. METHODS:ED directors at Level I ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2010.03.004
更新日期:2010-06-01 00:00:00
abstract:STUDY OBJECTIVE:We compare test characteristics of abdominal computed tomography (CT) with and without oral contrast for identifying intra-abdominal injuries. METHODS:This was a planned subanalysis of a prospective, multicenter study of children (<18 years) with blunt torso trauma. Children imaged in the emergency dep...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.annemergmed.2015.01.014
更新日期:2015-08-01 00:00:00
abstract::Experimental data have suggested that pneumatic external counterpressure improves outcome in intra-abdominal hemorrhage by either a tamponade effect and/or elevation in central systemic blood pressure. As a result, the empiric use of the pneumatic antishock garment (PASG) has become a standard of care, even to the poi...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1016/s0196-0644(87)80064-1
更新日期:1987-06-01 00:00:00