Heart rate response to intravenous catheter placement.

OBJECTIVE: To investigate the relationship between change in heart rate and pain and anxiety caused by intravenous catheter (IV) placement. METHODS: An observational study was performed in a university-based tertiary care emergency department. Patients who required IV placement as part of their management were considered as possible subjects. Heart rates were recorded at the following times: baseline, tourniquet placement, and IV placement. Immediately after IV placement, subjects recorded pain and anxiety scores using 100-mm visual analog scales. Percentage change in heart rate (compared with baseline) was calculated at time of tourniquet placement (anxiety) and IV placement (pain). Simple linear regression analyses were performed comparing pain scores with percent change in heart rate at the time of IV and tourniquet placement. Significance was defined as p < 0.05. RESULTS: Ninety subjects were enrolled. Subjects had a mean age of 48 years, and 54% were women. There was a normal distribution of heart rate changes, with greater than 80% of all subjects having a 10% or less change in heart rates. The results of the analysis of pain scores versus percentage change in heart rate at IV placement yielded a Pearson correlation coefficient of 0.13 (p = 0.2). The results of the analysis of anxiety scores versus percentage change in heart rate at tourniquet placement yielded a Pearson correlation coefficient of 0.014 (p = 0.9). CONCLUSIONS: Changes in heart rate do not correlate with pain and anxiety associated with IV placement.

The effect of practitioner characteristics on patient pain and embarrassment during ED internal examinations.

UNLABELLED: The objective was to determine if practitioner characteristics influence patients' pain and embarrassment during an emergency department (ED) internal pelvic examination (IPE). This prospective, comparative study was performed in an urban, university teaching hospital ED with an annual census of 64,000. The study population consisted of a convenience sample of patients who required an IPE as part of her ED evaluation. Information gathered included patient age and final diagnosis, as well as examiner gender and level of training (LOT). Immediately after IPE, the patient was asked to rate both pain and embarrassment of the examination using a previously validated 100-mm visual analog scale (VAS). Finally, each subject was asked to indicate her practitioner gender preference for IPE. The influence of examiner gender and LOT on patient pain and embarrassment was assessed using a t-test or ANOVA with significance defined as P <.05. A total of 278 subjects completed the study (mean age 27.7 +/- 10.5 years, range 13 to 70 years). The mean pain and embarrassment scores were 29.7 and 17.5 respectively. Examiner gender, examiner LOT and patient age did not predict pain and embarrassment scores. Overall, 173 (62%) patients had no practitioner gender preference, whereas 93 (34%) preferred women and 11 (4%) preferred men. CONCLUSION: Examiner characteristics do not influence either the pain or the embarrassment associated with IPE in the ED.

Midazolam syrup as a premedication to reduce the discomfort associated with pediatric intravenous catheter insertion.

This randomized, double-blind, placebo-controlled study evaluated midazolam syrup for reducing discomfort from intravenous placement in children 9 months to 6 years. Parents and observers rated the child's discomfort by using visual analogue scales. Median parents' pain scores were significantly lower in the midazolam than the placebo group (P =.002). Midazolam effectively reduces discomfort associated with intravenous insertion.

Nebulized fentanyl for relief of abdominal pain.

OBJECTIVE: To compare the efficacies of nebulized vs. intravenous fentanyl for the relief of abdominal pain. METHODS: This randomized, double-blind, double-placebo-controlled study compared nebulized and intravenous fentanyl (1.5 micro g/kg). Group I received intravenous fentanyl and nebulized saline. Group II received nebulized fentanyl and intravenous saline. Pain scores were measured at baseline and at 15 and 30 minutes after the study drug, using a 100-mm visual analog scale. Thirty minutes after the study drug, the subjects were offered rescue medication. The groups were compared for changes in pain scores at 30 minutes (primary outcome, t-test), changes in pain scores at 15 minutes (t-test), and need for rescue medication (Fisher's exact test). Significance was defined as p < 0.05. RESULTS: Fifty subjects (24 group I, 26 group II) were enrolled. The groups were similar with respect to mean baseline pain (72 mm group I, 74 mm group II) and demographics. A statistically significant difference in changes in pain scores at 15 minutes favoring group I (25 mm vs. 10 mm, p = 0.005) was not evident by 30 minutes (25 mm vs. 16 mm, p = 0.24). The groups were not different with respect to need for rescue medication (50% in group I compared with 69% in group II, p = 0.25). CONCLUSIONS: Nebulized fentanyl provides comparable analgesia to that of intravenous fentanyl.

Knowledge of prescription medications among elderly emergency department patients.

STUDY OBJECTIVE: We determine how knowledgeable elderly (>65 years old) patients seen in the emergency department are of their prescription medications. METHODS: Patients older than 65 years who presented to the ED of an urban teaching hospital were interviewed concerning their prescription medications and the indications for their use. Medications and dosages were verified through the patients' pharmacies. Medication indications were assessed for accuracy by referencing the Physicians' Desk Reference. RESULTS: Data on 88 patients were collected over a period of 2 months. Eleven patients were excluded from the study because of logistics (9) and rescinding of consent (2). Patients averaged 5.9 prescription medications on presentation to the ED. Patients correctly identified 78.4% (359/458) of these medications. Thirty-three (42.8%) patients were able to correctly identify all of their prescription medications. Furthermore, patients correctly identified 65.5% (236/359) of dosages (25 [32.5%] patients named all dosages correctly), 91.4% (328/359) of dosing intervals (44 [57.1%] patients named all intervals correctly), and 83.3% (299/359) of indications (49 [63.3%] patients named all indications correctly). CONCLUSION: Elderly patients presenting to the ED have only a fair knowledge of their prescription medications.

Physician and patient factors influencing the treatment of low back pain.

Previous retrospective studies have suggested that patient demographics may influence analgesic administration. These studies have not taken physicians' impression of patient pain into account. This prospective study investigates the influence of (i) physician impression of the degree of pain and (ii) patient demographics on the use of analgesic. A convenience sample of adults with non-traumatic lower back pain was studied. Possible predictors of analgesic administration included physician pain scores (assessed by visual analogue scale), patient ethnicity, gender, age, and insurance. These variables were tested individually and then using logistic regression. For the total of 91 patients enrolled, only physician pain scale was found to be associated with analgesic use. Median scores were 68 mm (interquartile range = 62-80 mm) for those receiving treatment versus 48 mm (interquartile range = 30-58 mm) for those who did not (P < 0.001). This study therefore suggests that physician impression of patient pain rather than patient demographics influences analgesic use.