Emergency medicine journal : EMJ
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A clinically suspected scaphoid fracture with normal initial plain x-rays is a difficult but common problem. The role of MRI as a diagnostic modality in this situation was analysed based on the experience of 611 consecutive cases. ⋯ MRI is a useful and effective tool in the diagnosis of radiologically occult wrist injuries. It is feasible to do MRI scans in a timely manner in a district general hospital.
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There is growing interest in the safety of oxygen therapy in emergency patients. A Cochrane review of oxygen versus air for patients with acute myocardial infarction (AMI) showed a potentially important, but statistically non-significant, increase in mortality (RR 3.03 (95% CI 0.93 to 9.83)) and concluded a definitive randomised controlled trial (RCT) was needed. ⋯ Widespread belief in the benefit of oxygen in AMI may make it difficult to persuade funders of the importance of this issue and health professionals to participate in enrolling patients into a trial in which oxygen would be withheld from half their patients.
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Emergency physicians frequently undertake emergency procedural sedation in non-fasted patients. At present, no UK guidelines exist for pre-procedural fasting in emergency sedation, and guidelines from the North American Association of Anesthesiologists (ASA) designed for general anaesthesia (GA) are extrapolated to emergency care. A systematic review of the literature was conducted with the aim of evaluating the evidence for risk of pulmonary aspiration during emergency procedural sedation in adults. ⋯ Furthermore, ASA guidelines for fasting prior to GA are based on questionable evidence, and there is high-level evidence that demonstrates no link between pulmonary aspiration and non-fasted patients. There is no reason to recommend routine fasting prior to procedural sedation in the majority of patients at the Emergency Department. However, selected patients believed to be significantly more prone to aspiration may benefit from risk:benefit assessment prior to sedation.
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Paroxysmal supraventricular tachycardia (SVT) is a relatively common problem presented to the emergency department. Most sources advocate the use of vagal manoeuvres as first-line management, including Valsalva manoeuvre. Despite this, there is lack of standardisation as to how the technique is performed. There is currently no 'gold standard' Valsalva manoeuvre. We propose a modified Valsalva manoeuvre, based on techniques described in small-scale electrophysiological studies, but no large clinical trials. ⋯ Our findings support previous observations that there is lack of standardisation as to how Valsalva is performed, and an apparent reliance on adenosine. The impact of introducing this technique as our departmental standard was a raise in non-pharmacological reversion from 5.3% to 31.7% with no reported significant adverse effects.
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Randomized Controlled Trial
Effects of training time and feedback on ventilation skills in lay rescuers.
Lay rescuers have difficulties acquiring ventilation skills during training. Non-feedback manikins are still widely employed, although skill acquisition is suboptimal. We analysed if a longer training time and verbal feedback, given by an instructor, improved ventilation skill acquisition with non-feedback manikins. ⋯ Both 10 and 20 min ventilation training times resulted in comparable skills. Volunteers hyperventilated the manikin and produced excessive stomach inflation in this model. This increased even further after verbal feedback.