The American journal of emergency medicine
-
Randomized Controlled Trial Multicenter Study
Management of severe acute pain in emergency settings: ketamine reduces morphine consumption.
The aim of the study was to compare in emergency settings 2 analgesic regimens, morphine with ketamine (K group) or morphine with placebo (P group), for severe acute pain in trauma patients. ⋯ Ketamine was able to provide a morphine-sparing effect.
-
Randomized Controlled Trial
Expanding the use of topical anesthesia in wound management: sequential layered application of topical lidocaine with epinephrine.
Topical anesthesia eliminates the need for injection of anesthetic. Most studies on the use of topical anesthesia were done on children, using 3 active ingredients (lidocaine, epinephrine, tetracaine, or tetracaine, adrenaline, cocaine) for relatively small wounds of the face and scalp. ⋯ Topical lidocaine and epinephrine "sequential layered application" is an effective, safe, and less painful method of anesthesia for a wide variety of lacerations. Patients recall their experience with this technique very favorably.
-
Comparative Study
External cardiac defibrillation during wet-surface cooling in pigs.
During surface cooling with ice-cold water, safety and effectiveness of transthoracic defibrillation was assessed. ⋯ Transthoracic defibrillation is safe and effective in a wet condition after cooling with ice-cold water.
-
Dyspnea is one of the most common emergency department (ED) symptoms, but early diagnosis and treatment are challenging because of multiple potential causes. Hemodynamic parameters may aid in the evaluation of dyspnea, but are difficult to assess. Impedance cardiography is a noninvasive hemodynamic measurement method that may assist in early ED decision making. ⋯ Impedance cardiography data result in improvement in ED physician differentiation of cardiac from noncardiac causes of dyspnea.
-
Emergency department (ED) patients with fractures, dislocations, or abscesses of the upper extremities often require closed reduction or incision and drainage to treat these conditions. Procedural sedation is often necessary when infiltration of local anesthetic provides insufficient analgesia. Anesthesiologists commonly perform supraclavicular brachial plexus nerve blocks to achieve analgesia for upper extremity surgery. We report a series of 5 ED patients in whom supraclavicular brachial plexus nerve blocks using real-time ultrasound guidance provided excellent analgesia and obviated the need for procedural sedation.