Emergency medicine journal : EMJ
-
A short cut review was carried out to establish cricoid pressure reduced aspiration during rapid sequence induction (RSI) of anaesthesia. A total of 241 papers were identified using the reported search, of which three represented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. There is little evidence to support the widely held belief that the application of cricoid pressure reduces the incidence of aspiration during a rapid sequence intubation.
-
All medical practitioners working within the NHS are subject to annual appraisal and in the future revalidation. Medical responders acting on behalf of NHS Ambulances Trusts often working in a voluntary capacity will require appraisal either individually (those working exclusively in prehospital care) or jointly (for hospital practitioners or GP's who are also involved prehospital care). They will be required to demonstrate satisfactorily adherence to the principles of clinical governance and develop a CPD portfolio. ⋯ To establish a mutual understanding between the Ambulance Services and medical practitioners the Faculty of Prehospital Care has met with stakeholders to establish a code of practice which has been agreed and endorsed by the Ambulance Service Association. This document clearly defines both individual and joint responsibilities to establish good practice. For many practitioners much of what is contained in this document will already be in place.
-
This prospective observational study aimed to determine the rate of success of reduction of dislocated hip prostheses using conscious sedation. In 101 consecutive patients presenting to the emergency department between August 2000 and February 2003 with a dislocated hip prosthesis, reduction was attempted using conscious sedation. The outcome measures of the study were (a) rate of success of the attempted reductions (b) rate of complication of the sedation or the procedure, and (c) rate of success in the three subgroups (based on degree of dislocation). ⋯ The mean time to attempted reduction using conscious sedation was 1.83 hours and for an equivalent group who were excluded and subsequently required general anaesthesia the mean time was 10.9 hours. Reduction of isolated unilateral prosthetic hip dislocation using conscious sedation in the emergency department is safe and has a reasonable success rate. Prosthetic hip reduction can be attempted more quickly using conscious sedation than when awaiting general anaesthesia.
-
A chest radiograph performed to check the position of a central venous catheter in a patient appeared to show a pneumothorax. Intercostal drain insertion was prepared. Reassessment of the patient and a further radiograph confirmed that the "pneumothorax" was an artefact from a prominent skin fold due to the patient's body habitus.
-
A short cut review was carried out to establish the best way to immobilise dislocated shoulders after reduction. A total of 47 papers were identified using the reported search, of which four represent the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. For patients with a first anterior shoulder dislocation immobilisation in external rotation may be of more benefit than immobilisation in internal rotation.