Emergency medicine journal : EMJ
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Clinical Trial
The Lancaster experience of 2.0 to 2.5 mg/kg intramuscular ketamine for paediatric sedation: 501 cases and analysis.
To report the experience of using intramuscular ketamine 2.0 or 2.5 mg/kg for minor painful procedures in children in a medium sized district general hospital accident and emergency department. To demonstrate the safety and acceptability of ketamine and determine if the incidence of adverse effects is related to dose or other variables. ⋯ 2.0 - 2.5 mg/kg intramuscular ketamine sedation is a safe and acceptable technique when used within a defined protocol. Lower dose ketamine (2 mg/kg) warrants further study in view of potentially less airway complications and quicker discharge times than previously reported.
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To further evaluate the safety profile and efficacy of intramuscular ketamine for procedural sedation during paediatric minor procedures in the emergency department and to ascertain parental satisfaction with the treatment of their children. ⋯ High levels of satisfaction among parents and staff together with the avoidance of hospital admission and improved resource management should be a sufficient incentive for hospital trusts to consider the establishment of this type of service.
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Emergency rapid sequence intubation (RSI) performed outside the operating room on emergency patients is the cornerstone of emergency airway management. Complication rates are unknown for this procedure in the United Kingdom and the factors contributing to immediate complications have not been identified. ⋯ RSI has a significant immediate complication rate, although the clinical significance of transient events is unknown. The likelihood of immediate complications depends on the patient's underlying condition, and relevant diagnoses should be emphasised in airway management training. Complication rates are comparable between anaesthetists and non-anaesthetists. The significantly lower complication rates in emergency department RSI can be explained by a larger proportion of patients with comparatively stable cardiorespiratory function.
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Blackthorn (Prunus spinosus), a member of Rosacea family is well known for causing infections and tissue reactions of synovial structures. Three interesting cases of cystic blackthorn granuloma, blackthorn synovitis with digital nerve entrapment, and multiple blackthorn syndrome are presented. Removal of foreign body fragments and surrounding reactive tissues resulted in an uneventful recovery with full return of joint and tendon functions.
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A simple algorithm has been produced to assist front line ground ambulance personnel, air ambulance crews, and immediate care doctors attending trauma patients in selecting the most appropriate mode of transport from the incident scene to hospital.