The American journal of emergency medicine
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Multicenter Study Comparative Study
Propofol versus midazolam for procedural sedation in the emergency department: A study on efficacy and safety.
Procedural sedation for painful procedures in the emergency department (ED) can be accomplished with various pharmacological agents. The choice of the sedative used is highly dependent on procedure- and patient characteristics and on personal- or local preferences. ⋯ A total of 592 ED sedations were included in our study. Patients sedated with propofol (n=284, median dose 75mg) achieved a deeper level of sedation (45% vs. 25% deep sedation, p<0.001), had a higher procedure success rate (92% vs. 81%, p<0.001) and shorter median sedation duration (10 vs. 17min, p<0.001) compared to patients receiving midazolam (n=308, median dose 4mg). A total of 112 sedation events were registered for 99 patients. Transient apnea was the most prevalent event (n=73), followed by oxygen desaturation (n=18) airway obstruction responsive to simple maneuvers (n=13) and hypotension (n=6). Propofol sedations were more often associated with the occurrence of apnea's (20% vs. 10%, p=0.004), whereas clinically relevant oxygen desaturations (<90%) were found more often in patients sedated with midazolam (8% vs. 1%, p=0.001). No sedation adverse events were registered CONCLUSION: Propofol is more effective and at least as safe as midazolam for procedural sedation in the ED.
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Letter Randomized Controlled Trial Comparative Study
Comparison of Macintosh and AWS Pentax laryngoscope for intubation in cervical immobilization scenario.
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Comparative Study
A retrospective analysis of nebulized versus intravenous fentanyl for renal colic.
To assess the effectiveness of nebulized fentanyl used for analgesia in renal colic. ⋯ Nebulized fentanyl provides effective analgesia in patients with renal colic. However, iv fentanyl exhibits more rapid and more powerful analgesic effects than nebulized fentanyl. Nonetheless, due to its ease of use and few potential risks and side-effects the nebulized form can be used as an alternative in renal colic.
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Review Case Reports
Delayed cardiac tamponade: A rare but life-threatening complication of catheter ablation.
Delayed cardiac tamponade (DCT) is a rare and life-threatening complication of catheter ablation performed as a treatment of atrial fibrillation, with few cases described in the medical literature. We present the case of a 57year-old man presenting with DCT 61days following a catheter ablation procedure. To the best of our knowledge, this is the most delayed case of cardiac tamponade (CT) following catheter ablation described in the literature. ⋯ Some proposed mechanisms of DCT include small pericardial hemorrhages following post-procedural anticoagulation or rupture of the sealed ablation-induced left atrial wall [2]. Clinical examination and electrocardiography may be helpful. However, the criterion standard for diagnosing CT is echocardiography [3].
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Though hospitals' operational continuity is crucial, full institutional evacuation may at times be unavoidable. The study's objective was to establish criteria for discharge of patients during complete emergency evacuation and compare scope of patients suitable for discharge pre/post implementation of criteria. ⋯ The study's findings enable to forecast the extent of patients that may be released home during full emergency evacuation of a hospital; thereby facilitating preparedness of contingency plans.