Emergency medicine journal : EMJ
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The superiority of ultrasonic-guided compared with landmark-guided central venous catheter (CVC) placement is not well documented in the Emergency Department. ⋯ Only one single high quality study illustrating that ED ultrasound- versus landmark-guided internal jugular catheter placement had higher success rates with lower complication rates.
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A short-cut review was carried out to establish whether pelvic immobilisation with a T-POD, or similar device, or pelvic immobilisation with a wrapped sheet is better at fracture stabilisation. Three papers were relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in table 2. The clinical bottom line is that these devices/techniques do reduce and stabilise some fractures, whether one device is better than another is unclear.
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Healthcare organisations have started to examine the impact that the human worker has on patient safety. Adopting the Crew Resource Management (CRM) approach, used in aviation, the CRM or non-technical skills of anaesthetists, surgeons, scrub practitioners and emergency physicians have recently been identified to assist in their training and assessment. Paramedics are exposed to dynamic and dangerous situations where patients have to be managed, often with life-threatening injuries or illness. ⋯ The aim of this paper was to review the literature on the non-technical (social and cognitive) skills used by paramedics. This review was undertaken as part of a task analysis to identify the non-technical skills used by paramedics. Of the seven papers reviewed, the results have shown very little research on this topic and so reveal a gap in the understanding of paramedic non-technical skills.
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A short-cut review was carried out to establish whether pelvic immobilisation with a pelvic compression device or with a wrapped sheet would provide haemorrhage control. Four studies were relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in table 3. The clinical bottom line is that both may provide some haemorrhage control, but there is insufficient evidence to recommend one over the other
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A short-cut review was carried out to establish whether flushing an intraosseous needle with local anaesthetic or saline is more effective at reducing the pain injecting drugs or fluid via this route. Two studies were relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in table 1. The clinical bottom line is that injecting lidocaine both before and after flushing an intraosseous needle is an effective method of reducing the pain of fluid infusion via this route.