I was pleased when I opened my mailbox today, and the new Academic Emergency Medicine burst out. It’s really a treat, on par with my subscription to the New Yorker. Why? Because AEM really expands my concept of what research, and emergency medicine, can be. I’m not kidding, and I’m not damning by faint praise (and EM is too small a community for me to get away with it, if I were).
The first article that caught my eye was entitled, Laser-assisted Anesthesia Reduces the Pain of Venous Cannulation in Children and Adults. Now, over the past year I’ve become pretty good at starting IV’s, I’m starting to incorporate ultrasound guidance on some tricky, urgent cases. But I’ve never really focused on minimizing pain, as my patients can attest. In the OR I’ve seen the anesthesia residents sometimes use lidocaine (and I certainly give it before a spinal tap) but I had no idea lasers were an option. Apparently, using a handheld laser over the planned IV site will ablate th topmost layer of skin, allowing transdermal anesthetics to seep though. Patients reported less pain in a randomized controlled trial (the patients and researchers were also blinded, though it’s not clear whether it was by design protocol, or from the power of the lasers).
Anyway, the next time I see an administrator strolling through the ED, I’m going to ask for a handheld laser. The evidence supports it, patients love it, and I’ve always, always wanted a laser gun.
Another eye-catching study was called, Single Question about Drunkenness to Detect College Students at Risk for Injury. The question was, "Hey, buddy, want to go grab a drink?"
Ha! No. I kid. The question was "In a typical week, how many days do you get drunk?" Any answer greater than or equal to "1" was associated with a fivefold increase in EtOH-related injury, a more than twofold increase in falls requiring medical treatment, and a more than twofold increase in being sexually assaulted. It’s a better marker than binge drinking, or anything else out there. The study was limited to ten North Carolina colleges — we’ll see if it’s generalizable beyond that. But the ED is a great place to make an intervention in a young college kid’s life, and this one question is a heck of a start.
It’s not all great in this month’s AEM — I was a little disappointed that Childhood Injuries Caused by Falling Televisions didn’t contain any blockbuster revelations (did you know there’s no ICD-9 code for falling televisions? for shame!) but on the whole this journal kind of inspires me. Anyone else out there a fan of AEM?