J Emerg Med
-
Comparative Study Clinical Trial
Efficacy of intranasal naloxone as a needleless alternative for treatment of opioid overdose in the prehospital setting.
Prehospital providers are at increased risk for blood-borne exposure and disease due to the nature of their environment. The use if intranasal (i.n.) medications in high-risk populations may limit this risk of exposure. To determine the efficacy of i.n. naloxone in the treatment of suspected opiate overdose patients in the prehospital setting, a prospective, nonrandomized trial of administering i.n. naloxone by paramedics to patients with suspected opiate overdoses over a 6-month period was performed. ⋯ Seven patients (16%) in this group required further doses of i.v. naloxone. In conclusion, i.n. naloxone is a novel alternative method for drug administration in high-risk patients in the prehospital setting with good overall effectiveness. The use of this route is further discussed in relation to efficacy of treatment and minimizing the risk of blood-borne exposures to EMS personnel.
-
The variable accuracy of emergency department (ED) ultrasound described in the literature has limited its utility as the sole imaging modality in critical decision making. Although ultrasound accuracy is highly dependent upon the technical abilities of the operator and conditions unique to each patient, no previous study of ED ultrasound has included estimates of operator confidence. This prospective observational study explores the association between operator confidence and the accuracy of ED ultrasound. ⋯ Logistic regression revealed an association between confidence and ED ultrasound accuracy (p < 0.001). It is concluded that a significant association exists between operator confidence and the accuracy of ED ultrasound. High confidence values are associated with clinically useful test performance characteristics.
-
Emergency Medicine (EM) is a developing specialty in Peru, as is the case in many other countries around the world. The nation's first residency training program was started in 1993 at the Universidad Nacional Mayor de San Marcos (UNMSM). This description of the development, organization, challenges, and goals of the EM specialty in Peru is based on personal experience and communication with other specialists in the country.
-
Winged scapula is a well-described condition associated with a wide variety of injuries and conditions. It is typically due to dysfunction of the serratus anterior or trapezius muscles, often secondary to long thoracic or accessory nerve palsies. Given the potential for permanent disability, winged scapula is an important diagnosis to consider in any patient presenting with shoulder pain or weakness.
-
This article describes a combination maneuver for the reduction of anterior glenohumeral dislocations. It maximizes the force counter to the patient's musculature by using downward motion, with the physician's body mass and gravity doing the work, and the base of the ED gurney providing countertraction. ⋯ Because minimal sedation and analgesia is necessary, this technique may be useful for shoulder reductions at sporting events, wilderness areas, or accident scenes. It may also expedite the care of patients in busy emergency department settings.