Emergency medicine journal : EMJ
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Advanced Trauma Life Support (ATLS) courses teach a system for the initial assessment and management of trauma patients that aims to optimise initial care and reduce mortality and morbidity, and have been adopted worldwide. This questionnaire survey characterised those who took up this particular educational resource in Scotland during a four year period after its introduction, and analysed how they felt it had affected their clinical competence. Irrespective of their previous level of training and experience, nearly all surgeons and anaesthetists who took this course felt that it had improved their clinical skills and other professional attributes. The significance of these results is discussed in the context of postgraduate surgical and anaesthetic training in Scotland.
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A case is reported of the Lazarus phenomenon (the return of spontaneous circulation after cardiopulmonary resuscitation had been abandoned) in a patient following recreational drug use. The implications for management of cardiac arrest in the emergency department are discussed.
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Studies from the United States (US) suggest that using a chest pain observation unit (CPOU) saves from $567 to $2,030 per case compared with hospital admission. These savings will only be reproduced in the United Kingdom (UK) if the cost of routine hospital admission is similar. This study aimed to review current practice to determine the proportion of patients suitable for CPOU evaluation, the cost per case of routine admission and compare this with control groups in US studies. ⋯ Potential exists for the introduction of CPOU care to reduce health service costs in the UK. However, the magnitude of cost savings demonstrated in US studies were achieved by comparison to relatively high inpatient costs and should not be extrapolated. Economic evaluation of the CPOU should be repeated in the UK. The inclusion of interventional cardiology costs is an important determinant of cost effectiveness.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation.
This study compared intranasal midazolam (INM) with a combination of intravenous ketamine and intravenous midazolam (IVKM) for sedation of children requiring minor procedures in the emergency department. ⋯ Intravenous ketamine plus midazolam used in an appropriate setting by experienced personnel provides an excellent means of achieving sedation suitable for most non-painful minor procedures for children in the emergency department. This combination is superior to INM in terms of speed of onset and consistency of effect. INM delivered via aerosol spray has a more variable effect but may still be adequate for the completion of many of these procedures.
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For pre-hospital spinal immobilisation the spinal board is the established gold standard. There are concerns that its subsequent use in hospital may adversely affect patient outcome. This review examines the effect of prolonged patient immobilisation on the spinal board. ⋯ The spinal board should be removed in all patients soon after arrival in accident and emergency departments, ideally after the primary survey and resuscitation phases.