RESUMO
STUDY OBJECTIVE: Studies in US emergency departments have demonstrated that pain is undertreated in adults and children. Previous studies have also demonstrated cultural differences in the expression and perception of pain. The objective of this investigation was to describe the analgesic practices and patient pain responses in two Costa Rican EDs in light of possible differences due to cultural variation. METHODS: We carried out a prospective, noninterventional observational assessment protocol of a convenience sample of patients being treated for orthopedic trauma in two university-affiliated urban teaching hospital EDs. Children between the ages of 5 and 12 years and all adults, ages 16 to 63, who presented with painful orthopedic trauma were included. Patients quantified their pain on arriving at and before leaving the ED. Children used a Face Interval Scale ranging from 1 (no pain) to 9 (maximum pain), and adults used a numeric rating scale ranging from 0 to 10. RESULTS: One fourth of pediatric and more than half of all adult patients had no reduction in their pain scores on leaving the ED. Eleven percent of adults and fewer than 4% of children received pain treatment while in the ED. Fewer than half of all patients were sent home with analgesics. We observed no use of opioids in the ED for analgesia. CONCLUSION: Our data illustrate that both adults and children with severe pain resulting from orthopedic injury in the Costa Rican EDs we studied often receive inadequate or no analgesic treatment. This finding suggests that the phenomenon of oligoanalgesia is more widespread and resistant to cultural differences. We also noted a reluctance to use opioids in this setting.
Assuntos
Analgesia/métodos , Serviço Hospitalar de Emergência , Ortopedia , Manejo da Dor , Ferimentos e Lesões/terapia , Doença Aguda , Adolescente , Adulto , Analgesia/estatística & dados numéricos , Criança , Pré-Escolar , Costa Rica , Características Culturais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ortopedia/estatística & dados numéricos , Dor/etiologia , Medição da Dor/estatística & dados numéricos , Estudos Prospectivos , Ferimentos e Lesões/complicaçõesRESUMO
This prospective, clinical study was performed to determine the utility of the syringe aspiration technique (SAT) to verify endotracheal tube (ETT) position. Ninety consecutive patients requiring urgent intubation in the emergency department or prehospital setting were enrolled in the study. The SAT correctly identified intratracheal ETT placement in 88 patients and esophageal misplacement in 2 patients. Ultimately, standard detection techniques were used to confirm ETT placement. The SAT was an accurate means of verifying ETT placement.
Assuntos
Intubação Intratraqueal/métodos , Sucção/métodos , Seringas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Testes Respiratórios , Dióxido de Carbono/análise , Criança , Pré-Escolar , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Falha de Equipamento , Estudos de Avaliação como Assunto , Humanos , Lactente , Intubação Intratraqueal/efeitos adversos , Laringoscopia , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Sons Respiratórios , Sensibilidade e Especificidade , Sucção/instrumentaçãoRESUMO
Subungual hematoma is a commonly encountered problem in the emergency department. We designed a prospective, observational study to determine if treatment of simple subungual hematomas (SUH) by nail trephination alone is without cosmetic or infectious complications. Over a 2-year study period, 48 patients met inclusion criteria. Radiographs of all digits were taken to detect distal phalangeal fracture and SUH size was measured. Nail trephination was performed using electrocautery, and all patients reported relief of pain after the procedure. Follow-up was achieved in 45 of 48 patients with a total of 47 SUH. Average follow-up period was 10.3 +/- 4.3 months. By patient history, average time for the nail to grow back was 4.0 +/- 2.6 months. No complications of infection, osteomyelitis, or major nail deformities occurred in any patients treated by nail trephination, regardless of SUH size or presence of fracture. In simple SUH, regardless of size, nail removal with suture repair of the nail bed, as suggested in previous studies, is unnecessary.
Assuntos
Eletrocoagulação , Hematoma/cirurgia , Unhas/lesões , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Unhas/cirurgia , Estudos ProspectivosAssuntos
Auxiliares de Emergência/educação , Cuidados para Prolongar a Vida/métodos , Traumatologia/educação , Protocolos Clínicos/normas , Currículo , Humanos , Sociedades Médicas/organização & administração , Transporte de Pacientes/métodos , Transporte de Pacientes/normas , Traumatologia/métodos , Traumatologia/normasRESUMO
Contact lens wearers who develop complications related to their lens use are likely to present to emergency departments for care. The pathophysiology of contact lens complications is outlined, and clinical presentations of various conditions related to both soft and hard lens wear are summarized. Guidelines for emergency department management are suggested.
Assuntos
Doenças da Túnica Conjuntiva/etiologia , Lentes de Contato/efeitos adversos , Doenças da Córnea/etiologia , Doenças da Túnica Conjuntiva/patologia , Doenças da Túnica Conjuntiva/terapia , Doenças da Córnea/patologia , Doenças da Córnea/terapia , HumanosRESUMO
Transcutaneous cardiac pacing (TCP) is a promising prehospital intervention, but there are little data available regarding protocols to improve patient tolerance to TCP. A 50:50 nitrous oxide:oxygen analgesic mixture also is a commonly employed prehospital intervention. In this randomized, prospective study, we compared the discomfort experienced by 18 healthy subjects when paced in two trials at the capture threshold: one following breathing of a 50:50 nitrous oxide:oxygen mixture; and the second only breathing room air. Discomfort was rated on an analog scale from 1 (minimal discomfort) to 10 (severe pain). Of the 18 subjects, 15 (83%) reported that nitrous oxide improved the tolerance to pacing at capture threshold. The median pain scores at capture threshold in the nitrous oxide and room air group were 3.8 and 5.0 respectively (P less than .05). Nine of the subjects tolerated TCP for the maximum allotted time of 30 seconds in each trial; six tolerated TCP for a longer time period in the nitrous oxide trial; three tolerated TCP longer in the room air trial. These data suggest that inhalation of 50:50 nitrous oxide:oxygen mixture may improve tolerance to TCP in the conscious patient.
Assuntos
Estimulação Cardíaca Artificial/métodos , Óxido Nitroso/administração & dosagem , Analgesia/métodos , Estimulação Cardíaca Artificial/efeitos adversos , Serviços Médicos de Emergência , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Distribuição AleatóriaRESUMO
Verification of endotracheal tube (ETT) location in prehospital setting and the emergency department (ED) is a challenging task. Unrecognized esophageal intubations with potentially dangerous consequences may occur more frequently in these environments than in less hectic settings. To evaluate the capabilities of a portable, non-directable, fiberoptic bronchoscope (Visicath; Saratoga Medical, Saratoga, Calif., USA) to detect appropriate ETT placement, a prospective series of 22 intubated prehospital, air-medical, or ED patients underwent fiberoptic verification (FOV) of a newly placed ETT. Each patient was intubated under urgent circumstances. The time required for FOV, ETT location, the relative difficulty of intubation, and the changes in management as a result of FOV were recorded. A total of 24 FOVs were performed, twenty-one tracheal (88%), and two esophageal (8%) intubations were identified. Position could not be identified in one case (4%). FOV confirmed placement in 23 intubations (96%) in less than 25 seconds. Seven intubations (29%) were judged to be "difficult." FOV resulted in five minor changes in management (22%) and was the sole confirmation method for five intubations. We conclude that fiberoptic verification is a promising method of ETT position in air-medical and ED intubations.