Emergency medicine journal : EMJ
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Randomized Controlled Trial Comparative Study
Amethocaine versus EMLA for successful intravenous cannulation in a children's emergency department: a randomised controlled study.
Topical anaesthetics reduce the pain of venous cannulation. The emergency department at the Starship Children's Hospital in Auckland uses EMLA (an eutectic mixture of 25 mg/g lidocaine and 25 mg/g prilocaine) for topical anaesthesia. Amethocaine has recently been shown to be a more effective topical anaesthetic. It is suggested that, because amethocaine does not vasoconstrict veins, it may increase the success of cannulation. ⋯ Amethocaine is not more successful than EMLA for first attempt intravenous cannulation in a children's emergency department.
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Randomized Controlled Trial Comparative Study
Comparison of powered and conventional air-purifying respirators during simulated resuscitation of casualties contaminated with hazardous substances.
Advanced life support of patients contaminated with chemical, biological, radiological or nuclear (CBRN) substances requires adequate respiratory protection for medical first responders. Conventional and powered air-purifying respirators may exert a different impact during resuscitation and therefore require evaluation. This will help to improve major incident planning and measures for protecting medical staff. ⋯ Powered air-purifying respirators improve the ease of breathing and do not appear to reduce mobility or delay treatment during a simulated resuscitation scenario inside an ambulance vehicle with a single CBRN casualty.
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Multicenter Study
Predicting admission and mortality with the Emergency Severity Index and the Manchester Triage System: a retrospective observational study.
To compare the degree to which the Emergency Severity Index (ESI) and the Manchester Triage System (MTS) predict admission and mortality. ⋯ Both the ESI and MTS predicted admission well. The ESI was a better predictor of admission than the MTS. Mortality is associated with urgency categories of both triage systems.
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Multicenter Study
Use of prehospital dressings in soft tissue trauma: is there any conformity or plan?
Acute soft tissue wounds are commonly seen in the prehospital setting. It was hypothesised that there is a lack of consistency in early management of trauma wounds, particularly in the dressings used. ⋯ This study confirmed that there is currently no national standard protocol for early acute wound management in the prehospital care setting. The key areas for improvement are cleansing, simplification of dressings and the introduction of standardised protocols and teaching.
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Comparative Study
Predictors of the need for rapid sequence intubation in the poisoned patient with reduced Glasgow coma score.
In patients presenting to the emergency department (ED) with significant poisoning and reduced Glasgow coma score (GCS), the decision to proceed with rapid sequence intubation can be a difficult one. Traditionally, patients with a GCS of 8 or less are thought to require airway protection. It has been found that a number of these patients can be managed safely without advanced airway support in a well-monitored ward environment. The objective of this study was to define the key physiological indicators of intubation requirement in this complex group of patients. ⋯ Clinical assessment by experienced medical staff rather than physiological variables are the key to determining intubation requirements in the poisoned patient with reduced GCS. GCS alone is not a good predictor of intubation.