Emergency medicine journal : EMJ
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Randomized Controlled Trial Multicenter Study
STOP!: a randomised, double-blind, placebo-controlled study of the efficacy and safety of methoxyflurane for the treatment of acute pain.
To evaluate the short-term efficacy and safety of methoxyflurane for the treatment of acute pain in patients presenting to an emergency department (ED) with minor trauma. ⋯ The results of this study suggest that methoxyflurane administered via the Penthrox inhaler is an efficacious, safe, and rapidly acting analgesic.
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Comparative Study
Clinical scaphoid score (CSS) to identify scaphoid fracture with MRI in patients with normal x-ray after a wrist trauma.
The aim of this study was to compare a combination of three commonly used tests to identify scaphoid fractures with MRI in patients with normal x-ray after a wrist trauma. ⋯ If a patient with wrist pain after injury and normal x-ray has a CSS≥4 (pain in the anatomical snuffbox in addition to pain at scaphoid tubercle or longitudinal compression or both) we recommend MRI. A CSS <4 has a negative predictive value of 96%, which makes scaphoid fracture unlikely.
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Randomized Controlled Trial
A double-blind, randomised, placebo-controlled trial of oral midazolam plus oral ketamine for sedation of children during laceration repair.
To compare the efficacy of oral midazolam alone with a combination of oral midazolam and ketamine in children requiring laceration repair. ⋯ The trial was registered in www.clinicaltrials.gov as NCT01470157.
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A short-cut review was carried out to establish whether prophylactic antiemetic agents reduce the incidence of vomiting in immobilised patients who have suffered trauma. A total of 137 papers were found using the reported searches, of which two 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 these papers are tabulated. It is concluded that prophylactic use of antiemetic agents in trauma patients may reduce the likelihood of vomiting some 5-12-fold.
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The Greater Sydney Area Helicopter Emergency Medical Service provides physicians for undertaking prehospital and inter-hospital critical care. We quantified the obstetric caseload of our service with respect to primary diagnosis and interventions in order to provide targeted physician training. ⋯ A half of all peri-partum patients in our critical care transport service are retrieved for non-obstetric diagnoses. Obstetric interventions by retrieval physicians are rare, but resuscitative hysterotomy may be required. Most interventions are general critical care procedures. Exhaustive training in obstetric emergencies may not reflect the learning needs of retrieval physicians in services such as ours. Educational resources should prioritise general critical care of the pregnant woman rather than specific obstetric procedures. We have used these findings to construct a targeted obstetric module as part of our retrieval physician training programme.