European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Review Meta Analysis
The role of venous blood gas in the Emergency Department: a systematic review and meta-analysis.
The aim of this study is to provide a systematic review of the literature reporting agreement between arterial and venous pH, partial pressure of carbon dioxide (PCO2), bicarbonate (HCO3⁻), base excess and lactate; and to perform a meta-analysis of the differences. Medline and Embase searches using Eduserv Athens from 1950 to present were conducted using the terms 'VBG', 'ABG', 'arterial', 'venous', 'blood', 'gas', 'lactate', 'emergency' and 'department'. References of the published papers were hand searched and full-text versions of those deemed helpful to the question were obtained. ⋯ Arteriovenous agreement for PCO2 is poor and PvCO2 cannot be relied upon as an absolute representation of PaCO2. However, normal peripheral PvCO2 has a good negative predictive value for normal arterial PCO2, and a normal PvCO2 can be used as a screen to exclude hypercapnic respiratory disease. There may be a poor agreement between arterial and venous lactate at abnormal values; however, if the venous lactate is normal, it is likely the arterial values of this parameter will also be normal.
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Review Meta Analysis
Transcutaneous electrical nerve stimulation for relieving acute pain in the prehospital setting: a systematic review and meta-analysis of randomized-controlled trials.
Although medics in many services are equipped with pharmacological analgesia, legislative or logistical restrictions in some systems result in the need to rely on nonpharmacological avenues for the management of acute pain. Transcutaneous electrical nerve stimulation (TENS) has been proposed as an alternative to analgesic medication that could be feasible and effective in the prehospital setting. The aim of this systematic review was to determine the effectiveness and safety of TENS when administered by medics to patients with acute pain in the prehospital setting. ⋯ TENS was also effective in reducing acute anxiety secondary to pain. No safety risks were identified. When administered by medics in the prehospital setting to patients with acute pain, TENS appears to be an effective and safe nonpharmacological analgesic modality that should be considered by emergency medical services organizations in which pharmacological pain management is restricted or unavailable.
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Review
Ultrasound-guided peripheral venous access: a systematic review of randomized-controlled trials.
To systematically review the current literature on the effect of using ultrasound (US) guidance for the placement of peripheral intravenous (PIV) catheters in patients with difficult access. ⋯ On the basis of this review, routine use of US guidance for PIV placement is not strongly supported by the literature.
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The aim of this paper, is to present a case to develop and test emergency department (ED)-specific approaches to improve the sequential detection, recognition and timely escalation of care for ED patients who have deteriorated after their initial triage and assessment. ⋯ A systematic approach to the early recognition of, and response to, deteriorating ED patients across the entire ED trajectory of care remains untested. Given the complexities of the ED environment, ward-based models of recognizing and responding to deteriorating patients may not meet the specific needs of the ED.
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Secondary hazards are an important consideration when dealing with both self-poisoned and chemically contaminated patients. Secondary exposure of hospital staff following the admission of a poisoned patient is relatively rare but potentially serious. Risks usually arise from chemical conversion of a deliberately ingested toxic substance and subsequent offgassing, but there may be toxic substances on the victim or their clothing. ⋯ This paper presents a narrative review that considers some of the more commonly encountered toxic chemicals and situations that may present secondary hazards in hospitals. Risks to staff can be lowered by reducing the potential for, and duration of, exposure wherever possible. Good communication with the first responders at the scene, consultation with experts, decontamination and use of personal protective equipment, together with regular training, can minimize risks in the hospital environment.