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 usual care and would differ by a clinically significant amount. METHOD:This was a pragmatic randomized controlled trial of patient-controlled analgesia and usual care (opioid and dose at physician's discretion) in 4 EDs. Entry criteria included age 18 to 65 years and acute pain requiring intravenous opioids. The primary outcome was decline in numeric rating scale pain score 30 to 120 minutes postbaseline. Secondary outcomes included satisfaction, time to analgesia, adverse events, and patient-controlled analgesia pump-related problems. We used a mixed-effects linear model to compare rate of decline in pain (slope) between groups. A clinically significant difference between groups was defined as a difference in slopes equivalent to 1.3 numeric rating scale units. RESULTS:Six hundred thirty-six patients were enrolled. The rate of decline in pain from 30 to 120 minutes was greater for patients receiving patient-controlled analgesia than usual care (difference=1.0 numeric rating scale unit; 95% confidence interval [CI] 0.6 to 1.5; P<.001) but did not reach the threshold for clinical significance. More patients receiving patient-controlled analgesia were satisfied with pain management (difference=9.3%; 95% CI 3.3% to 15.1%). Median time to initial analgesia was 15 minutes longer for patient-controlled analgesia than usual care (95% CI 11.4 to 18.6 minutes). There were 7 adverse events in the patient-controlled analgesia group and 1 in the usual care group (difference=2.0%; 95% CI 0.04% to 3.9%), and 11 pump-programming errors. CONCLUSION:The findings of this study do not favor patient-controlled analgesia over usual ED care for acute pain management.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Bijur PE,Mills AM,Chang AK,White D,Restivo A,Persaud S,Schechter CB,Gallagher EJ,Birnbaum AJdoi
10.1016/j.annemergmed.2017.03.064subject
Has Abstractpub_date
2017-12-01 00:00:00pages
809-818.e2issue
6eissn
0196-0644issn
1097-6760pii
S0196-0644(17)30360-8journal_volume
70pub_type
杂志文章,随机对照试验abstract：:Leeches have been used as a medicinal remedy for years untold. Recently, there appears to have been a resurgence in the use of the medicinal leech, Hirudo medicinalis. Presented is the case of a patient who called the emergency department for advice concerning the management of a bleeding leech bite. We discuss briefl...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(89)80422-6
更新日期：1989-03-01 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：:Few tools exist that are sufficiently robust to allow manipulation of key input variables to produce casualty estimates resulting from high-consequence events reflecting local or specific regions of concern. This article describes the design and utility of a computerized modeling simulation tool, Electronic Mass Casua...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2008.09.014
更新日期：2009-02-01 00:00:00
abstract：:Patients who suffer an in-hospital cardiac arrest represent a neglected and underutilized resource for resuscitation research. There exists an unwritten, but widely held, belief among resuscitation researchers that the in-hospital arrest population is unsuitable for resuscitation research because it is composed mostly...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,评审
doi：10.1016/s0196-0644(05)80263-x
更新日期：1993-01-01 00:00:00
abstract：:Acute ischemic stroke is the third leading cause of death in the United States and the leading cause of adult disability. The direct and indirect costs of stroke care exceed $51 billion annually. In 1996, the US Food and Drug Administration approved the first treatment for acute ischemic stroke, intravenous tissue pla...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,评审
doi：10.1067/mem.2001.111573
更新日期：2001-02-01 00:00:00
abstract：:Olfactory and gustatory hallucinations are not often encountered in the acute care setting but may represent the subtle presenting features of a significant underlying disease process. We describe a patient whose most striking presenting symptoms were of olfactory and gustatory hallucinations and in whom the diagnosis...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2010.02.020
更新日期：2010-10-01 00:00:00
abstract：:The Institute of Medicine and other national organizations have asserted that current payment policies strongly discourage emergency medical services (EMS) providers from transporting selected patients who call 911 to non-ED settings (eg, primary care clinics, mental health centers, dialysis centers) or from treating ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2013.09.025
更新日期：2014-05-01 00:00:00
abstract：:Breath alcohol analyzers are used to detect ethanol in motorists and others suspected of public intoxication. One concern is their ability to detect interfering substances that may falsely increase the ethanol reading. A 47-year-old-man was found in a public park, acting intoxicated. A breath analyzer test (Intoxilyze...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2009.07.021
更新日期：2010-02-01 00:00:00
abstract：:Acoustic otoscopy detects middle ear pathology by measuring the ability of the tympanic membrane to reflect sound. Fluid or thickening of the tympanic membrane increases sound reflection. We conducted a study to compare acoustic otoscopy with pneumatic otoscopy in identifying middle ear pathology in 80 children (160 e...
journal_title：Annals of emergency medicine
pub_type： 临床试验,杂志文章
doi：10.1016/s0196-0644(89)80578-5
更新日期：1989-04-01 00:00:00
abstract：STUDY OBJECTIVE:Patient-centered medical homes are primary care practices that focus on coordinating acute and preventive care. Such practices can obtain patient-centered medical home recognition from the National Committee for Quality Assurance. We compare growth rates for emergency department (ED) use and costs of ED...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2015.01.002
更新日期：2015-06-01 00:00:00
abstract：:The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents training in those programs. We present the 2016 annual report on the status of US emergency medicine training programs. ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2016.03.031
更新日期：2016-05-01 00:00:00
abstract：:A double-blind, randomized study was performed to determine the occurrence of ventricular arrhythmias in acute asthma patients treated with epinephrine, aminophylline, or both in combination. Sixty patients were studied with Holter monitoring during the 90-minute study period. There was no statistical difference among...
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(86)80428-0
更新日期：1986-06-01 00:00:00
abstract：:The rapid expansion of cost-consciousness and managed care into the medical marketplace has challenged the autonomy of physicians and patients. These challenges have taken a variety of forms, including limitations on reimbursement and restrictions on the amount and type of emergency care patients may receive. Challeng...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(96)70094-x
更新日期：1996-12-01 00:00:00
abstract：:In order to assess more rationally the requirement for anticoagulation during intraoperative autotransfusion, the clotting competence of blood collected from the body cavities of 31 trauma victims entering our emergency department with indications for intraoperative transfusion was assessed. Blood was collected at tho...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(81)80375-7
更新日期：1981-03-01 00:00:00
abstract：:As administrators evaluate potential approaches to improve cost, quality, and throughput efficiencies in the emergency department (ED), "front-end" operations become an important area of focus. Interventions such as immediate bedding, bedside registration, advanced triage (triage-based care) protocols, physician/pract...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,评审
doi：10.1016/j.annemergmed.2009.05.021
更新日期：2010-02-01 00:00:00
abstract：STUDY OBJECTIVE:Physicians often prescribe antibiotics to patients even when there is no clear indication for their use. Previous studies examining antibiotic use in acute bronchitis and upper respiratory infections have been conducted in primary care settings. We evaluate the factors that physicians in the emergency d...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,多中心研究
doi：10.1016/j.annemergmed.2007.03.026
更新日期：2007-09-01 00:00:00
abstract：:During a 3-month period, a 33-year-old man presented to the emergency department on 4 occasions with dyspnea, palpitations, and syncope. His initial presentation was accompanied by acute myocardial injury and ventricular fibrillation. An extensive evaluation spanned the 3 months and included echocardiography, cardiac ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2005.02.002
更新日期：2005-06-01 00:00:00
abstract：STUDY OBJECTIVE:We evaluated a strategy to increase use of the test (Dix-Hallpike's test [DHT]) and treatment (canalith repositioning maneuver [CRM]) for benign paroxysmal positional vertigo in emergency department (ED) dizziness visits. METHODS:We conducted a stepped-wedge randomized trial in 6 EDs. The population wa...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,多中心研究,随机对照试验
doi：10.1016/j.annemergmed.2019.09.017
更新日期：2020-04-01 00:00:00
abstract：:A 19-year-old man who attempted suicide by ingesting approximately 600 mg fluoxetine (Prozac) and 140 mg loxapine (Loxitane) had two episodes of atrial flutter shortly thereafter. Admission serum fluoxetine, norfluoxetine, and loxapine levels were 1,053 ng/mL, 702 ng/mL, and 40 ng/mL, respectively. This case of atrial...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(94)70083-4
更新日期：1994-03-01 00:00:00
abstract：STUDY OBJECTIVE:We determine the association between use of specific cephalosporins and macrolides and hospital length of stay in patients with sickle cell disease (SCD) who are admitted with acute chest syndrome, and determine treatment risk factors for acute chest syndrome-related 30-day readmission. METHODS:Patient...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2020.08.011
更新日期：2020-09-01 00:00:00
abstract：STUDY OBJECTIVE:Coronary computed tomographic (CT) angiography has excellent performance characteristics relative to coronary angiography and exercise or pharmacologic stress testing. We hypothesize that coronary CT angiography can identify a cohort of emergency department (ED) patients with a potential acute coronary ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2008.09.025
更新日期：2009-03-01 00:00:00
abstract：:A patient with a 70% hydrofluoric acid burn developed systemic dissemination of fluoride ion from a 9% to 10% body surface area exposure on the lower extremities. Severe hypocalcemia and intractable ventricular arrhythmias resulted. This case is the second documented occurrence of hypocalcemia from hydrofluoric acid b...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(85)81078-7
更新日期：1985-02-01 00:00:00
abstract：:We describe the case of a 41-year-old man who suffered a bite to the tongue from the Western Diamondback rattlesnake (C atrox). Life-threatening obstruction of his upper airway secondary to massive edema of the tongue and other soft tissue structures quickly followed envenomation. Nasotracheal intubation, IV antivenin...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(87)80584-x
更新日期：1987-07-01 00:00:00
abstract：STUDY OBJECTIVE:We characterize repeat pediatric emergency department visits and determine the cause for such visits as an indicator of potential need for quality improvement. We hypothesized that most repeat ED visits resulting in hospitalization do not represent medical errors. METHODS:The study was performed at a l...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1067/mem.2002.116595
更新日期：2002-02-01 00:00:00
abstract：:To evaluate the hypothesis that all victims of severe blunt trauma require a pelvic radiograph, we prospectively studied all such patients admitted to the Southern New Jersey Regional Trauma Center during a seven-month period. All patients were classified as unconscious; impaired; awake, alert, and symptomatic; or ale...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(88)80244-0
更新日期：1988-05-01 00:00:00
abstract：:A series of 10 seriously injured patients requiring resuscitation and definitive operative control of hemorrhage was studied. Simultaneous arterial and mixed venous blood gases were measured sequentially throughout the resuscitative and operative periods. Improvement of the mixed venous oxygen saturation was associate...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(80)80002-3
更新日期：1980-04-01 00:00:00
abstract：STUDY OBJECTIVE:This study investigated the hypothesis that modern computed tomographic (CT) imaging is sufficient to exclude subarachnoid hemorrhage (SAH) in patients with severe headache. METHODS:All 38,730 adult patients who presented to Hermann Hospital in Houston, Texas, during a 16-month period were prospectivel...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：
更新日期：1998-09-01 00:00:00
abstract：:This report describes a case of near-fatal intoxication following accidental exposure to 1, 1, 1-trichloroethane in a child. This solvent, generally safe, is widely used to 1, 1, 1-trichloroethane in a child. This solvent, generally safe, is widely used in industrial and domestic preparations. Exposure to high levels ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(81)80011-x
更新日期：1981-10-01 00:00:00
abstract：STUDY OBJECTIVE:Previous studies suggest improved patient outcomes for providers who perform high volumes of complex medical procedures. Out-of-hospital tracheal intubation is a difficult procedure. We seek to determine the association between rescuer procedural experience and patient survival after out-of-hospital tra...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2009.12.020
更新日期：2010-06-01 00:00:00
abstract：STUDY OBJECTIVE:The prevalence of agitation among emergency department (ED) patients is increasing. Physical restraints are routinely used to prevent self-harm and to protect staff, but are associated with serious safety risks. To date, characterization of physical restraint use in the emergency setting has been limite...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2018.06.020
更新日期：2019-02-01 00:00:00
