Emergency medicine Australasia : EMA
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Emerg Med Australas · Aug 2011
Review Meta AnalysisReview article: Prophylactic metoclopramide for patients receiving intravenous morphine in the emergency setting: a systematic review and meta-analysis of randomized controlled trials.
The objective of the present study was to conduct a systematic review and meta-analysis of randomized controlled trials, comparing metoclopramide with placebo, for preventing vomiting in patients who have received i.v. morphine for acute pain in the emergency setting, and to determine the level of evidence supporting the use of prophylactic metoclopramide in this population. Comprehensive systematic electronic searches were conducted of MEDLINE, EMBASE and the Cochrane Library for randomized controlled trials addressing the clinical question. Reference lists of identified articles were hand-searched. ⋯ All three studies were included in the final meta-analysis that demonstrated an overall result of no difference between metoclopramide and placebo for the primary outcome of vomiting (odds ratios 0.72; 95% confidence intervals 0.11-4.58). There was little evidence that routine prophylactic administration of metoclopramide following the administration of i.v. morphine for acute pain management in the emergency setting is clinically beneficial. Routine metoclopramide administration might expose patients to a risk of harm which is not justifiable given a lack of evidence of benefit.
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Emerg Med Australas · Aug 2011
Multicenter StudyFactors associated with failure to successfully complete a procedure during emergency department sedation.
To determine factors associated with failure to successfully complete a procedure during sedation in the ED. ⋯ Procedures performed under sedation in the ED have a low failure rate. However, increased body weight and specific procedures, such as hip reduction, are associated with significantly higher failure rates. Special consideration should be given to these patient groups before undertaking sedation in the ED.
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Emerg Med Australas · Aug 2011
Case ReportsNecrotizing enterocolitis in a 16-day-old, term neonate.
Necrotizing enterocolitis in a term neonate is a rare presentation to the ED. Prompt diagnosis and management is critical because of its rarity and the reported mortality of 5-20%. We report a case of necrotizing enterocolitis in a term neonate who presented at 16 days of age with bloody stool.