Changes in heart rate do not correlate with changes in pain intensity in emergency department patients.

The objective of this study was to determine the correlation, if any, between change in heart rate (HR) and change in pain in Emergency Department (ED) patients. This was a prospective, observational study of a convenience sample of patients presenting to an academic ED with pain. Heart rate and pain intensity (using a 100-mm visual analog scale) were determined at time of triage, 30 min post pain treatment, and at discharge. The correlation between change in HR and change in pain was determined using the Pearson correlation coefficient. Nine hundred seventy-five patients were enrolled in the study. The Pearson rho for 1143 correlations between change in HR and change in pain was 0.08 (95% CI 0.03-0.13). This study suggests that there is a poor correlation between change in pain intensity and change in heart rate among ED patients with acute pain.

Efficacy of intranasal naloxone as a needleless alternative for treatment of opioid overdose in the prehospital setting.

Prehospital providers are at increased risk for blood-borne exposure and disease due to the nature of their environment. The use if intranasal (i.n.) medications in high-risk populations may limit this risk of exposure. To determine the efficacy of i.n. naloxone in the treatment of suspected opiate overdose patients in the prehospital setting, a prospective, nonrandomized trial of administering i.n. naloxone by paramedics to patients with suspected opiate overdoses over a 6-month period was performed. All adult patients encountered in the prehospital setting as suspected opiate overdose (OD), found down (FD), or with altered mental status (AMS) who met the criteria for naloxone administration were included in the study. i.n. naloxone (2 mg) was administered immediately upon patient contact and before i.v. insertion and administration of i.v. naloxone (2 mg). Patients were then treated by EMS protocol. The main outcome measures were: time of i.n. naloxone administration, time of i.v. naloxone administration, time of appropriate patient response as reported by paramedics. Ninety-five patients received i.n. naloxone and were included in the study. A total of 52 patients responded to naloxone by either i.n. or i.v., with 43 (83%) responding to i.n. naloxone alone. Seven patients (16%) in this group required further doses of i.v. naloxone. In conclusion, i.n. naloxone is a novel alternative method for drug administration in high-risk patients in the prehospital setting with good overall effectiveness. The use of this route is further discussed in relation to efficacy of treatment and minimizing the risk of blood-borne exposures to EMS personnel.