Siamak Moayedi, Michael Witting, Matthew Pirotte
BACKGROUND: The easy internal jugular (Easy IJ) technique involves placement of a single-lumen catheter in the internal jugular vein using ultrasound guidance. This technique is used in patients who do not have suitable peripheral or external jugular venous access. The efficacy and safety of this procedure are unknown. OBJECTIVE: We aimed to estimate efficacy and safety parameters for the Easy IJ when used in emergency department (ED) settings. METHODS: We conducted a prospective study of the Easy IJ in stable ED patients with severe intravenous access difficulty...
December 2016: Journal of Emergency Medicine
Maala Bhatt, David W Johnson, Jason Chan, Monica Taljaard, Nick Barrowman, Ken J Farion, Samina Ali, Suzanne Beno, Andrew Dixon, C Michelle McTimoney, Alexander Sasha Dubrovsky, Nadia Sourial, Mark G Roback
Importance: Procedural sedation for children undergoing painful procedures is standard practice in emergency departments worldwide. Previous studies of emergency department sedation are limited by their single-center design and are underpowered to identify risk factors for serious adverse events (SAEs), thereby limiting their influence on sedation practice and patient outcomes. Objective: To examine the incidence and risk factors associated with sedation-related SAEs...
October 1, 2017: JAMA Pediatrics
Bernd Saugel, Thomas W L Scheeren, Jean-Louis Teboul
The use of ultrasound (US) has been proposed to reduce the number of complications and to increase the safety and quality of central venous catheter (CVC) placement. In this review, we describe the rationale for the use of US during CVC placement, the basic principles of this technique, and the current evidence and existing guidelines for its use. In addition, we recommend a structured approach for US-guided central venous access for clinical practice. Static and real-time US can be used to visualize the anatomy and patency of the target vein in a short-axis and a long-axis view...
August 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
Mark Hauswald, Erik K Hauswald
No abstract text is available yet for this article.
September 2016: Academic Emergency Medicine
Joshua Bucher, Alex Koyfman
BACKGROUND: Intubation of the neurologically injured patient is a critical procedure that must be done in a manner to prevent further neurologic injury. Although many different medications and techniques have been used to meet specific needs, there is little to no evidence to support many claims. OBJECTIVE: To review the literature regarding important topics relating to intubating patients with neurologic injury. DISCUSSION: Airway management requires ideal preoxygenation and airway maneuvers to minimize manipulation of the larynx and to maximize first-pass success...
December 2015: Journal of Emergency Medicine
Simon Bugden, Karla Shean, Mark Scott, Gabor Mihala, Sean Clark, Christopher Johnstone, John F Fraser, Claire M Rickard
STUDY OBJECTIVE: Peripheral intravenous catheters are the most common invasive device in health care yet have very high failure rates. We investigate whether the failure rate could be reduced by the addition of skin glue to standard peripheral intravenous catheter care. METHODS: We conducted a single-site, 2-arm, nonblinded, randomized, controlled trial of 380 peripheral intravenous catheters inserted into 360 adult patients. The standard care group received standard securement...
August 2016: Annals of Emergency Medicine
Lisa Hartling, Andrea Milne, Michelle Foisy, Eddy S Lang, Douglas Sinclair, Terry P Klassen, Lisa Evered
BACKGROUND: Sedation is increasingly used to facilitate procedures on children in emergency departments (EDs). This overview of systematic reviews (SRs) examines the safety and efficacy of sedative agents commonly used for procedural sedation in children in the ED or similar settings. METHODS: We followed standard SR methods: comprehensive search; dual study selection, quality assessment, data extraction. We included SRs of children (1 month to 18 years) where the indication for sedation was procedure-related and performed in the ED...
May 2016: Academic Emergency Medicine
Praveen Maheshwari, Bradley Kelsheimer, Parul Maheshwari
No abstract text is available yet for this article.
April 2016: Canadian Journal of Anaesthesia
Victoria L Migdal, W Kelly Wu, Drew Long, Candace D McNaughton, Michael J Ward, Wesley H Self
OBJECTIVE: The objective of the study is to compare the risks and benefits of lumbar puncture (LP) to evaluate for subarachnoid hemorrhage (SAH) after a normal head computed tomographic (CT) scan. METHODS: This was an observational study of adult emergency department patients at a single hospital who presented with headache and underwent LP after a normal head CT to evaluate for SAH. Lumbar puncture results classified as indicating a SAH included xanthochromia in cerebrospinal fluid (CSF) or red blood cells in the final tube of CSF with an aneurysm or arteriovenous malformation on cerebral angiography...
November 2015: American Journal of Emergency Medicine
K L Goodall, A Brahma, A Bates, B Leatherbarrow
Retrobulbar haemorrhage (RBH) occurs in a variety of situations. It can complicate facial fractures, orbital surgery and retrobulbar injections and can occur spontaneously. It is relatively uncommon and sight-threatening RBH is even less common. If not detected early enough it can lead to devastating loss of vision. We have collected five cases of acute RBH, following trauma, associated with a profound reduction in vision. In each case a permanent loss of vision was avoided using a lateral canthotomy and inferior cantholysis approach to obtain urgent orbital decompression...
September 1999: Injury
Steven Roy Ballard, Robert W Enzenauer, Thomas O'Donnell, James C Fleming, Gregory Risk, Aaron N Waite
Retrobulbar hemorrhage is an uncommon, but potentially devastating complication associated with facial trauma. It can rapidly fill the orbit and cause an "orbital compartment syndrome" that subsequently cuts off perfusion to vital ocular structures, leading to permanent visual loss. Treatment must be initiated within a limited time in order to prevent these effects; however, specialty consultation is not always available in remote field environments. This article addresses the mechanism, diagnosis, and treatment ofretrobulbar hemorrhage via lateral canthotomy and cantholysis, and recommends that 18D medical sergeants be properly trained to evaluate and perform this sight-saving procedure in emergent settings where upper echelons of care are not immediately available...
2009: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Christopher S Weaver, Kevin M Terrell, Robert Bassett, William Swiler, Beth Sandford, Sara Avery, Anthony J Perkins
OBJECTIVE: Emergency physicians routinely perform emergency department procedural sedation (EDPS), and its safety is well established. We are unaware of any published reports directly evaluating the safety of EDPS in older patients (≥65 years old). Many EDPS experts consider seniors to be at higher risk. The objective was to evaluate the complication rate of EDPS in elderly adults. METHODS: This was a prospective, observational study of EDPS patients at least 65 years old, as compared with patients aged 18 to 49 and 50 to 64 years...
June 2011: American Journal of Emergency Medicine
Leonie Calver, Geoffrey K Isbister
PURPOSES: This study aimed to investigate sedation of elderly patients with acute behavioral disturbance (ABD) in the emergency department (ED), specifically the safety and effectiveness of droperidol. BASIC PROCEDURES: This was a prospective study of elderly patients (>65 years) with ABD requiring parenteral sedation and physical restraint in the ED. Patients were treated with a standardized sedation protocol that included droperidol. Drug administration, time to sedation, additional sedation, and adverse effects were recorded...
June 2013: American Journal of Emergency Medicine
Asad E Patanwala, Anna C Christich, Karalea D Jasiak, Christopher J Edwards, Hanna Phan, Eric M Snyder
BACKGROUND: Propofol dose requirements may differ in the elderly due to age-related changes in pharmacokinetic or pharmacodynamic variables. OBJECTIVE: The objective of this study was to determine the effect of patient age on propofol dose required for procedural sedation in the Emergency Department (ED). METHODS: This was a retrospective cohort study conducted in a tertiary hospital ED. Adult patients who underwent procedural sedation in the ED using propofol were grouped a priori by age into three categories: 18-40 years, 41-64 years, and ≥65 years...
April 2013: Journal of Emergency Medicine
Gregory W Hendey
No abstract text is available yet for this article.
January 2016: Annals of Emergency Medicine
Avinash Kanji, Paul Atkinson, Jacqueline Fraser, David Lewis, Susan Benjamin
INTRODUCTION: Little is understood about the relationship between delay to treatment and initial reduction success for anterior shoulder dislocation. Our study examines whether delays to initial treatment, from injury and hospital presentation, are associated with higher reduction failure rates for anterior shoulder dislocation. METHODS: A retrospective database and chart review was performed for patients undergoing intravenous sedation for attempted reduction of anterior shoulder dislocation in the emergency department (ED)...
February 2016: Emergency Medicine Journal: EMJ
Elena Martinez, Santiago Mintegi, Begoña Vilar, Maria Jesus Martinez, Amaia Lopez, Estibaliz Catediano, Borja Gomez
BACKGROUND: Classical criteria differ when performing cerebrospinal fluid (CSF) analysis in infants younger than 90 days with fever without a source (FWS). Our objectives were to analyze the prevalence and microbiology of bacterial meningitis in this group and its prevalence in relation to clinical and laboratory risk factors. METHODS: This is a substudy of a prospective registry including all infants of this age with FWS seen between September 2003 and August 2013 in a Pediatric Emergency Department of a Tertiary Teaching Hospital...
May 2015: Pediatric Infectious Disease Journal
Ben L C Wright, James T F Lai, Alexandra J Sinclair
Cerebrospinal fluid is vital for normal brain function. Changes to the composition, flow, or pressure can cause a variety of neurological symptoms and signs. Equally, disorders of nervous tissue may alter cerebrospinal fluid characteristics. Analysis of cerebrospinal fluid can provide information on diagnosis, may be therapeutic in certain conditions, and allows a research opportunity into neurological disease. However, inappropriate sampling, inaccurate technique, and incomplete analysis can contribute to significant patient morbidity, and reduce the amount of accurate information obtained...
August 2012: Journal of Neurology
Gavin Smith, Alicia Broek, David McD Taylor, Amee Morgans, Peter Cameron
OBJECTIVES: This study sought to determine the most effective technique for Valsalva Manoeuvre (VM) and Human Dive Reflex Manoeuvre (HDR) generation of vagal tone. METHODS: We conducted a repeated-measures trial of healthy adult volunteers from a university campus, aged 18-56 years, in sinus rhythm. Participants were randomised to VM (in supine or Trendelenberg postures) and HDR (supine or sitting postures) sequentially. Participants performed three trials of each technique, in random order, with a continuous ECG recording...
January 2015: Emergency Medicine Journal: EMJ
S A Bernard, K Smith, R Porter, C Jones, A Gailey, B Cresswell, D Cudini, S Hill, B Moore, T St Clair
INTRODUCTION: Pre-hospital intubation by paramedics is widely used in comatose patients prior to transportation to hospital, but the optimal technique for intubation is uncertain. One approach is paramedic rapid sequence intubation (RSI), which may improve outcomes in adult patients with traumatic brain injury. However, many patients present to emergency medical services with coma of non-traumatic cause and the role of paramedic RSI in these patients remains uncertain. METHODS: The electronic Victorian Ambulance Clinical Information System was searched for the term 'suxamethonium' between 2008 and 2011...
January 2015: Emergency Medicine Journal: EMJ
2015-01-09 03:24:10
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