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
RANDOMIZED CONTROLLED TRIAL
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
RANDOMIZED CONTROLLED TRIAL
Mariantina Fragou, Andreas Gravvanis, Vasilios Dimitriou, Apostolos Papalois, Gregorios Kouraklis, Andreas Karabinis, Theodosios Saranteas, John Poularas, John Papanikolaou, Periklis Davlouros, Nicos Labropoulos, Dimitrios Karakitsos
OBJECTIVE: Subclavian vein catheterization may cause various complications. We compared the real-time ultrasound-guided subclavian vein cannulation vs. the landmark method in critical care patients. DESIGN: Prospective randomized study. SETTING: Medical intensive care unit of a tertiary medical center. PATIENTS: Four hundred sixty-three mechanically ventilated patients enrolled in a randomized controlled ISRCTN-registered trial (ISRCTN-61258470)...
July 2011: Critical Care Medicine
Paul E Marik, Mark Flemmer, Wendy Harrison
BACKGROUND: Catheter-related bloodstream infections are an important cause of morbidity and mortality in hospitalized patients. Current guidelines recommend that femoral venous access should be avoided to reduce this complication (1A recommendation). However, the risk of catheter-related bloodstream infections from femoral as compared to subclavian and internal jugular venous catheterization has not been systematically reviewed. OBJECTIVE: A systematic review of the literature to determine the risk of catheter-related bloodstream infections related to nontunneled central venous catheters inserted at the femoral site as compared to subclavian and internal jugular placement...
August 2012: Critical Care Medicine
Ian G Stiell, Catherine M Clement, Jeffrey J Perry, Christian Vaillancourt, Cheryl Symington, Garth Dickinson, David Birnie, Martin S Green
OBJECTIVE: There is no consensus on the optimal management of recent-onset episodes of atrial fibrillation or flutter. The approach to these conditions is particularly relevant in the current era of emergency department (ED) overcrowding. We sought to examine the effectiveness and safety of the Ottawa Aggressive Protocol to perform rapid cardioversion and discharge patients with these arrhythmias. METHODS: This cohort study enrolled consecutive patient visits to an adult university hospital ED for recent-onset atrial fibrillation or flutter managed with the Ottawa Aggressive Protocol...
May 2010: CJEM
RANDOMIZED CONTROLLED TRIAL
Oh Sung Kwon, Gyu Chong Cho, Choong Hyun Jo, Young Suk Cho
BACKGROUND AND AIMS: Inserting a nasogastric tube (NGT) in intubated patients may be difficult because they cannot follow swallowing instructions, resulting in a high rate of first-attempt failure. We introduce a simple technique for inserting an orogastric tube in an emergency department (ED). METHODS: Fifty-six patients in the ED, who were intubated and required NGT insertion, were randomly allocated to 2 groups. We inserted the NGT using a conventional technique from the nostril (control group) and an endotracheal tube (ET)-assisted technique from the mouth (ET group)...
February 2015: American Journal of Emergency Medicine
Philip Kaye, Matthew Govier
Many emergency patients present with cardiac arrhythmias requiring emergency direct current countershock cardioversion (DCCV) as a part of their management. Almost all require sedation to facilitate the procedure. Propofol has been used for procedural sedation in Emergency Medicine since 1995. In 1996, in a review article in Anaesthesia, it was recommended as the drug which most closely approaches the ideal agent for DCCV. However, the existing evidence for the dosage requirements and safety of propofol in emergency DCCV is limited...
November 2014: Emergency Medicine Journal: EMJ
Richard A Harrigan, Theodore C Chan, Steven Moonblatt, Gary M Vilke, Jacob W Ufberg
Emergency Department placement of a temporary transvenous cardiac pacemaker offers potential life-saving benefits, as the device can definitively control heart rate, ensure effective myocardial contractility, and provide adequate cardiac output in select circumstances. The procedure begins with establishment of central venous access, usually by a right internal jugular or left subclavian vein approach, although the femoral vein is an acceptable alternative, especially in patients who are more likely to bleed should vascular access become complicated...
January 2007: Journal of Emergency Medicine
Fanny Voisin, Laurent Sohier, Yann Rochas, Mallorie Kerjouan, Charles Ricordel, Chantal Belleguic, Benoit Desrues, Stéphane Jouneau
STUDY OBJECTIVE: There is no consensus about the management of large spontaneous pneumothoraces. Guidelines recommend either needle aspiration or chest tube drainage and most patients are hospitalized. We assess the efficiency of ambulatory management of large spontaneous pneumothoraces with pigtail catheters. METHODS: From February 2007 to January 2011, all primary and secondary large spontaneous pneumothoraces from Lorient's hospital (France) were managed with pigtail catheters with a 1-way valve...
September 2014: Annals of Emergency Medicine
Bruce R Paix, William M Griggs
Surgical airway access justifiably remains the final option for managing the 'can't intubate can't ventilate' situation, but available techniques are often complicated and might require special equipment. This paper reports on the real world experience of two experienced Australian medical specialists with backgrounds in Anaesthesia and Aeromedical Retrieval who performed 24 surgical airways, mainly under adverse prehospital conditions, over a combined 40 years of practice. All attempts were successful, the majority through a simple open 'scalpel-finger-tube' method, which is described here...
February 2012: Emergency Medicine Australasia: EMA
P J Torok, S D Flinn, A Y Shin
This study assessed the efficacy of a modified transthecal digital block. Three-hundred-and-sixty consecutive digits were anaesthetised with this technique for the treatment of fractures, infections and foreign bodies. Complete palmar and dorsal anaesthesia was achieved in 357 of the 360 digits (99%), including 52 of 53 thumbs (98%). The technique was extremely easy to perform and no complications occurred.
February 2001: Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand
Raymond G Hart, Francisco A S Fernandas, Joseph E Kutz
The transthecal digital block is a simple, safe, and effective anesthesia technique that can be used in many digital injuries. It is contraindicated only in cases of infection. The purposes of this article are to (1) discuss the indications for the transthecal digital block, (2) describe the technique, and (3) review the literature. The transthecal technique is used on appropriate patients almost to the exclusion of more traditional digital blocks by many hand surgeons. The advantages of this method are that it requires only a single injection, has a rapid onset of action, and requires only a small amount of anesthetic...
May 2005: American Journal of Emergency Medicine
RANDOMIZED CONTROLLED TRIAL
Michael A Peterson, Deepti Pisupati, Theodore W Heyming, Jennifer A Abele, Roger J Lewis
OBJECTIVES: The objective was to determine if use of ultrasound (US) by emergency physicians (EPs) to localize spinal landmarks improves the performance of lumbar puncture (LP). METHODS: This was a prospective, randomized, controlled study conducted in a county teaching hospital. Subjects, adults 18 years of age or older who were to receive LPs for routine clinical care in the emergency department (ED), were randomized either to undergo US localization of the puncture site or to have the puncture site determined by palpation of spinal landmarks...
February 2014: Academic Emergency Medicine
Scott Schofield, Jacquie Schutz, Franz E Babl
OBJECTIVE: Distal forearm fractures frequently require reduction in children. We set out to survey how such fractures are currently reduced at Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites. METHODS: A survey was completed by paediatric emergency physicians at PREDICT sites. Survey questions covered departmental guidelines and resources and individual practice, agents used and limitations of fracture management using case vignettes...
June 2013: Emergency Medicine Australasia: EMA
Adam Balls, Frank LoVecchio, Amy Kroeger, J Stephan Stapczynski, Mary Mulrow, David Drachman
BACKGROUND: Ultrasound guidance of central venous catheter (CVC) insertion improves success rates and reduces complications and is recommended by several professional and regulatory organizations. METHODS: This is a prospective observational study using data extracted from the Central Line Emergency Access Registry database, a multicenter online registry of CVC insertions from medical centers throughout the United States. We compared success rates with ultrasound and with the anatomic-landmark technique...
June 2010: American Journal of Emergency Medicine
Steven A Godwin, John H Burton, Charles J Gerardo, Benjamin W Hatten, Sharon E Mace, Scott M Silvers, Francis M Fesmire
This clinical policy from the American College of Emergency Physicians is the revision of a 2005 clinical policy evaluating critical questions related to procedural sedation in the emergency department.1 A writing subcommittee reviewed the literature to derive evidence-based recommendations to help clinicians answer the following critical questions: (1) In patients undergoing procedural sedation and analgesia in the emergency department,does preprocedural fasting demonstrate a reduction in the risk of emesis or aspiration? (2) In patients undergoing procedural sedation and analgesia in the emergency department, does the routine use of capnography reduce the incidence of adverse respiratory events? (3) In patients undergoing procedural sedation and analgesia in the emergency department, what is the minimum number of personnel necessary to manage complications? (4) Inpatients undergoing procedural sedation and analgesia in the emergency department, can ketamine, propofol, etomidate, dexmedetomidine, alfentanil and remifentanil be safely administered? A literature search was performed, the evidence was graded, and recommendations were given based on the strength of the available data in the medical literature...
February 2014: Annals of Emergency Medicine
David Santos, Pierre-Nicolas Carron, Bertrand Yersin, Mathieu Pasquier
INTRODUCTION: Intraosseous access is increasingly recognised as an effective alternative vascular access to peripheral venous access. We aimed to prospectively study the patients receiving prehospital intraosseous access with the EZ-IO(®), and to compare our results with those of the available literature. METHODS: Every patient who required an intraosseous access with the EZ-IO from January 1st, 2009 to December 31st, 2011 was included. The main data collected were: age, sex, indication for intraosseous access, localisation of insertion, success rate, drugs and fluids administered, and complications...
April 2013: Resuscitation
Christopher Hill, Cliff Reid, Alex Tzannes, Brian Burns, Mark Bartlett
No abstract text is available yet for this article.
February 2013: Emergency Medicine Journal: EMJ
Mark J Seamon, John Chovanes, Nicole Fox, Raymond Green, George Manis, George Tsiotsias, Melissa Warta, Steven E Ross
Despite the establishment of evidence-based guidelines for the resuscitation of critically injured patients who have sustained cardiopulmonary arrest, rapid decisions regarding patient salvageability in these situations remain difficult even for experienced physicians. Regardless, survival is limited after traumatic cardiopulmonary arrest. One applicable, well-described resuscitative technique is the emergency department thoracotomy-a procedure that, when applied correctly, is effective in saving small but significant numbers of critically injured patients...
September 2012: Injury