Objectives: Patients report pain and discomfort with nasogastric tube (NGT) intubation. We tested the hypothesis that premedication with midazolam alleviates pain during NGT placement in the emergency department (ED) by > 13 on a 100-mm visual analog scale (VAS). Methods:We performed a double-blind randomized controlled pilot study, assigning ED patients requiring NGT placement to midazolam or placebo. All patients received intranasal cophenylcaine; additionally, they received an intravenous (IV) dose of the study drug, either 2 mg of IV midazolam or saline control. Nurses placed NGTs while observed by research staff, who then interviewed subjects to determine the primary outcome of pain using a VAS. Additional data collected from patients and their nurses included discomfort during the procedure, difficulty of tube insertion, and complications.Results: We enrolled 23 eligible patients and obtained complete data in all: 10 midazolam and 13 controls. We found a significant reduction in mean pain VAS score of À31 (95% confidence interval = À53 to À9 mm) with 2 mg of midazolam (mean AE SD = 52 AE 30 mm), compared to placebo (mean AE SD = 21 AE 18 mm), more than double the effect size considered clinically relevant. Treatment did not impact ease of placement and there were no serious adverse effects. Conclusions:Premedication with 2 mg of IV midazolam reduces pain of NGT insertion in ED patients without the need for full procedural sedation.ACADEMIC EMERGENCY MEDICINE 2016;23:766-771

Reported here are CP-FTMW experiments on N-ethylformamide (NEF), previously studied by pure rotational spectroscopy in the gas phase by Hirota and co-workers [J. Mol. Struct. 744 (2005) 815-819]. Two conformers of the monomer (trans sc and cis ac), the trans-trans sc dimer, and several NEF-water complexes have been detected. (Only trans sc was observed in the earlier experiments.) Of these species, the trans-trans sc dimer is the most interesting since its three-dimensional structure bears a striking resemblance to β-turns in folded peptides. The well-known anti-parallel β-sheet structures would be expected to have near-zero dipole moments and are therefore discriminated against by the CP-FTMW method.

BACKGROUND: Pulse oximetry has become the standard of care in emergency medicine, operating rooms, and medical wards for the monitoring of oxygenation, but the use of pulse oximetry for assessment of hemoglobin (Hb) is controversial. The purpose of this study was to compare the accuracy and precision of 2 point-of-care Hb measurement devices, the Pronto-7 and the HemoCue 201؉, to laboratory testing. METHODS: We studied a convenience sample of patients in the emergency department who required a complete blood count. We excluded patients in critical condition or those with elevated methemoglobin, impaired perfusion, or finger deformities. Each subject provided 2 capillary samples for measurement with the HemoCue 201؉ and 2 consecutive readings with the Pronto-7. We used Bland-Altman analysis to compare the performance of the point-of-care devices to laboratory measurements. We also determined the diagnostic performance for the detection of anemia by sex (Hb < 11.6 g/dL for females, Hb < 13.8 g/dL for males). RESULTS: 201 of the 350 subjects enrolled (57%) were female. Mean (SD) age was 50.9 (19.0) y. Complete data were available for 297 (84.9%) of the Pronto-7 readings and 323 (92.3%) of the HemoCue 201؉ readings. Mean (SD) laboratory Hb was 13.1 g/dL (2.3). Mean bias (Bland-Altman limits of agreement) for the Pronto-7 was ؊0.52 g/dL (؊3.29 to 2.25), and for the HemoCue 201؉ the mean bias was ؊0.98 g/dL (؊3.57 to 1.61). Sensitivity and specificity for diagnosis of anemia were 81.6% (95% CI 72.5-88.7) and 75.4% (95% CI 68.8-81.1) for the Pronto-7 and 99.1% (95% CI 94.8-100.0) and 71.0% (95% CI 64.4-76.9) for HemoCue 201؉. CONCLUSION: Both devices provided clinically useful methods to screen for anemia.

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