Emergency medicine journal : EMJ
-
Epidemiology, management and outcome of paracetamol poisoning in an inner city emergency department.
Paracetamol poisoning accounts for just under half of all self-poisoning cases that present to hospitals in England. Treatment with acetylcysteine is routine, yet recommendations regarding its use vary internationally and have recently been revised in England and Wales. ⋯ The recent changes in UK treatment guidelines are expected to increase the proportion of our population requiring acetylcysteine by 5.7%. We found no clear evidence that risk of anaphylactoid or more general adverse reaction to acetylcysteine was increased in patients presenting with lower blood paracetamol concentrations. Blood paracetamol level was highlighted as a potentially useful clinical indicator for risk of repeat self-harm.
-
We performed a systematic review of the literature to compare the efficacy of different drug therapies for the termination of stable, monomorphic ventricular tachycardia (VT). ⋯ Based on limited available evidence from small heterogeneous human studies, for the treatment of stable, monomorphic VT, procainamide, ajmaline and sotalol were all superior to lidocaine; amiodarone was not more effective than procainamide.
-
A shortcut review was carried out to establish whether bite blocks should be used when a laryngeal mask airway is used in the emergency department. Eighteen papers were found using the reported searches and a further eight were found by scanning the reference lists. ⋯ The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that bite guards should be used when laryngeal mask airways are employed in the emergency department.
-
A shortcut review was carried out to establish whether tranexamic acid improves outcomes for patients with life-threatening haematuria. Sixteen papers were found in Medline using the reported searches, of which four 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 best papers are tabulated. It is concluded that the evidence is limited, but there may be a role for tranexamic acid in life-threatening haematuria, particularly in patients with autosomal-dominant polycystic kidney disease.
-
Patients' gender remains a contributor for bias in pain management. Implementation of standardised analgesic protocols has been shown to minimise bias in analgesic care. The purpose of this study was to assess whether gender-related bias in pain management exists in our emergency department (ED) setting, where a standardised pain management protocol based on patients' subjective pain rating is routinely used. ⋯ Our findings suggest that a standardised pain management protocol based on patients' subjective pain rating may reduce gender-related bias in acute musculoskeletal pain management.