European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The inability to remove a ring from a finger is a common presentation to Emergency Departments in addition to Orthopaedic and Plastic Surgery Units. This is often complicated by factors including trauma and infection, leading to a superimposed tourniquet effect by the ring, strangulating the subcutaneous tissues. The threat of neurovascular compromise favours early removal of the ring to limit associated morbidity. This article illustrates the common methods within the literature. We offer assessing clinicians an illustrated summary of techniques for removing an incarcerated ring from an extremity and summarise notable considerations to be acknowledged at time of assessment and ring removal. ⋯ The ring removal techniques are ring preserving or destructive. The technique used depends on factors including the extent of associated trauma to the digit, evidence of strangulation, ring composition, patient preference and equipment availability. Before an attempt at ring removal, high arm elevation, indirect ice compression of the digit and adequate analgesia maximise chances of success. In cases of strangulation, emergent referral to a specialist is indicated for removal and further management.
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The administration of propofol target-controlled infusion (TCI) for procedural sedation is standard in a range of hospital settings except for the Emergency Department (ED). Propofol TCI could be an alternative, safer way to provide procedural sedation in the ED compared with other methods of propofol administration. We compare the incidence of adverse events using propofol TCI compared with other methods of propofol administration. ⋯ It was not possible to determine if propofol TCI reduces the incidence of adverse events when compared with other sedating regimens using propofol using a descriptive systematic review of the relevant literature. Further research is required to compare the incidence of adverse events using propofol TCI for procedural sedation with other methods of administration in the ED. Future systematic reviews and meta-analysis comparisons would be aided by the use of standard adverse event reporting tools such as that of the Society of Intravenous Anaesthesia.
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The Sendai Framework advocates the importance of training in disaster medicine as a way to improve health system resilience. In Italy, despite the official recognition of disaster medicine as a mandatory discipline in the standard curriculum, most students are never exposed to its basic concepts. DisasterSISM is a nationwide educational program in disaster medicine developed in 2008. Given the scarcity of experienced instructors, in 2013, the course adopted a peer-assisted learning (PAL) approach to correct the omission identified in the national curriculum. The new approach involved a training of trainers (ToT) and a basic course organized and delivered by certified student teachers. ⋯ By presenting this nationwide program and its outcomes, the authors hope to strengthen the case for including disaster medicine education in the standard medical curriculum. Because the course relies on medical students and PAL, the authors trust that it could be adapted to other countries worldwide.