Annals of emergency medicine
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Randomized Controlled Trial
The utility of supplemental oxygen during emergency department procedural sedation and analgesia with midazolam and fentanyl: a randomized, controlled trial.
To determine whether supplemental oxygen reduces the incidence of hypoxia by 20% in study patients receiving midazolam and fentanyl for emergency department procedural sedation and analgesia. ⋯ Supplemental oxygen did not reduce (or trend toward reducing) the incidence of hypoxia in patients moderately sedated with midazolam and fentanyl. However, our lower-than-expected rate of hypoxia limits the power of this comparison. Blinded capnography frequently identified respiratory depression undetected by the treating physicians.
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Randomized Controlled Trial Comparative Study
Randomized clinical trial of etomidate versus propofol for procedural sedation in the emergency department.
We compare the efficacy, adverse events, and recovery duration of etomidate and propofol for use in procedural sedation in the emergency department (ED). ⋯ Etomidate and propofol appear equally safe for ED procedural sedation; however, etomidate had a lower rate of procedural success and induced myoclonus in 20% of patients.
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Case Reports
Awake fiberoptic intubation using an optical stylet in an anticipated difficult airway.
Numerous rigid indirect fiberoptic and video-based airway tools have been developed as potential alternatives to direct laryngoscopy for intubation. Compared with flexible fiberoptic bronchoscopes, these devices are less expensive and may be easier to use. The role of these rigid instruments in managing the difficult airway in the emergency department is yet to be defined. This article details the use of a rigid fiberoptic stylet to manage an anticipated difficult airway by using topical anesthetic without sedation.
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Multicenter Study Comparative Study
Comparison of the effectiveness of trauma services provided by secondary and tertiary hospitals in Malaysia.
The trauma services provided by 6 hospitals operating at 2 levels of care (4 secondary or district general hospitals and 2 tertiary care hospitals) in Malaysia are compared in terms of mortality and disability for direct admissions to emergency departments to test the hypothesis that care at a tertiary care hospital is better than at a district general hospital. ⋯ Care at a tertiary care hospital was associated with reduced mortality (by 83% in severe injuries), but with a higher likelihood of disability and impairment, which has implications for improving access to trauma services for the severely injured in Malaysia and other low- and middle-income settings.
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Randomized Controlled Trial
Pilot study to evaluate the accuracy of ultrasonography in confirming endotracheal tube placement.
Visualization of the vocal cords and end-tidal capnography are the usual standards in confirming endotracheal tube placement. Vocal cord visualization is, however, not always possible, and capnography is not 100% reliable and requires ventilation of the lungs to confirm placement. The goal of this study is to determine the accuracy of ultrasonography for detecting endotracheal tube placement into the trachea and esophagus in real time. ⋯ In this pilot study, 2 emergency physicians experienced in ultrasonography accurately detected placement of endotracheal tubes during intubation with ultrasonography in select patients in the controlled environment of the operating room. Future studies should examine the use of ultrasonography to visualize endotracheal tube placement in real time by emergency physicians with less ultrasonographic training; use of the technique in the emergency department on a wider range of patients, including patients with difficult airways; and assessment of the utility of ultrasonography in confirmation of endotracheal tube position in already intubated patients.