Emergency medicine journal : EMJ
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Randomized Controlled Trial
Utility of the Pentax-AWS in performing tracheal intubation while wearing chemical, biological, radiation and nuclear personal protective equipment: a randomised crossover trial using a manikin.
Following a chemical, biological, radiation and nuclear (CBRN) incident, prompt establishment of an advanced airway is required for patients with respiratory failure within the warm zone, while wearing personal protective equipment (PPE). Previous studies reported that intubation attempts were prolonged, and incidence of esophageal intubation was increased with conventional Macintosh laryngoscope (McL), while wearing CBRN-PPE. Pentax-AWS (AWS), a recently introduced portable video laryngoscope, was compared with the McL to test its utility for tracheal intubation while wearing CBRN-PPE. ⋯ Although the CBRN-PPE adversely affected time required to complete tracheal intubation with the AWS, suited intubations using the AWS were even superior to unsuited intubations using the McL. The AWS should be a promising device to perform tracheal intubation while wearing the CBRN-PPE.
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Best Evidence Topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practicing clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. ⋯ Capillary blood gases as an alternative to arterial puncture in diabetic ketoacidosis. Effect of warming local anaesthetics on pain of infiltration. Use of tamsulosin in patients with urinary calculi to increase spontaneous stone passage.
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Review
BET 2: Is prehospital focused abdominal ultrasound useful during triage at mass casualty incidents?
A short-cut review was carried out to determined whether the addition of prehospital focused abdominal ultrasound to triage protocols might reduce time to necessary surgery and reduce overall mortality. Thirty-five papers were found using the reported searches, of which three presented 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 those best papers are shown in table 2. It is concluded that although the feasibility of prehospital ultrasound in mass casualty incidents has been demonstrated, there is, as yet, no clear evidence of benefit as part of a triage protocol.
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In water resuscitation has been reported to enhance the outcome of drowning victims. Mouth-to-mouth ventilation during swimming is challenging. Therefore, the efficacy of ventilation utilities was evaluated. ⋯ The use of Poseidon Cyklon 5000, Poseidon XStream and Scubapro Air2 regulators is consequently not recommended for in-water ventilation. With the limitation that the devices were tested with a test lung and not in a human field study, Apeks TX 100, Spiro Arctic and Buddy AutoAir might be used for emergency ventilation and probably ease in-water resuscitation for the dive buddy of the victim. Professional rescue divers could be equipped with the Oxylator and an oxygen tank to achieve an early onset of efficient in-water ventilation in drowning victims.
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High-sensitivity troponin assays facilitate the rapid exclusion of acute myocardial infarction (AMI). However, elevated results are also seen in other conditions causing myocardial injury. Serial measurements increase the specificity for AMI, helping to rapidly identify patients for whom revascularisation may be appropriate. In this study, we explore a strategy for rapidly excluding AMI in symptomatic patients using serial high-sensitivity troponin measurements. ⋯ (1) all patients presenting more than 3 h after symptom onset with a negative result had a second negative result; (2) AMI was excluded in all patients with two results falling below the lower limit of detection of a standard troponin assay by 8 h post-symptom onset.