European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Sharp wound debridement in local anaesthesia using EMLA cream: 6 years' experience in 1084 patients.
Sharp debridement is the most efficient method for clearing the woundbed in the exudation and granulation phase of wound healing. At our clinic the anaesthetic lidocaine-prilocaine cream, EMLA, has been used as an analgesic for sharp debridement since 1994. A review of patients' records was conducted, including ulcer size, dose of cream used, analgesic efficacy and complications. ⋯ We observed no allergic reactions, no clinical symptoms of local anaesthetic toxicity or methaemoglobinaemia. In 12 patients (1.1%) a burning sensation was reported directly after the application of EMLA cream to the ulcer, which, however, subsided within 15-20 min. In our experience, sharp debridement in percutaneous analgesia with EMLA is efficient, economical, safe, and tolerable for the patient.
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Case Reports
An unusual way to diagnose asymptomatic right ventricular perforation by a temporary endocardial pacing electrode.
Right ventricular perforation by a temporary endocardial pacing electrode can be fatal and needs to be detected promptly. This usually symptomatic situation is diagnosed by X-ray or echocardiographic findings. We present the case of a patient with an asymptomatic right ventricular perforation, in whom serial electrocardiograms enabled us to detect the displacement of the right ventricular lead.
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Randomized Controlled Trial Comparative Study Clinical Trial
Boussignac continuous positive airway pressure device in the emergency care of acute cardiogenic pulmonary oedema: a randomized pilot study.
This study aimed to assess the short-term respiratory effects of a new portable device that delivers a continuous positive airway pressure via a face mask (Boussignac-CPAP) in patients with severe acute cardiogenic pulmonary oedema, and the feasibility of using this technique in an emergency department. We prospectively studied 30 consecutive patients with acute cardiogenic pulmonary oedema. They were randomly assigned either to the Boussignac-CPAP valve, which delivered oxygen, or to standard oxygen delivery for a duration of 30 min. ⋯ Continuous positive pressure delivered using the Boussignac-CPAP device is feasible in an emergency care setting. It can quickly improve respiratory distress in acute cardiogenic pulmonary oedema patients. A larger trial should be initiated in such an emergency care setting to demonstrate the effectiveness of the Boussignac-CPAP device.
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Case Reports
Medial subtalar dislocation: importance of clinical diagnosis in distinguishing from other dislocations.
In an emergency situation, the clinical picture of ankle and subtalar dislocation may be similar. This may lead to the use of the improper technique of reduction, especially in a subtalar dislocation, resulting in the failure of reduction and further damage to the articular surfaces. A case of medial subtalar dislocation is presented, which was managed as an ankle dislocation and manipulated inappropriately, leading to a failure of reduction. The clinical signs of ankle and subtalar dislocation, including points of differentiation between the two are discussed, and the correct method of reduction of subtalar dislocation is described.
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Editorial Comment Biography Historical Article
International emergency medicine: the vision of a pioneer, Prof. Dr Peter Safar, on emergency medical care.