Emergency medicine journal : EMJ
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Randomized Controlled Trial
ABG needle study: a randomised control study comparing 23G versus 25G needle success and pain scores.
To determine whether a narrower gauge needle used in ABG sampling is associated with lower pain scores and complication rates without increasing the level of difficulty of the procedure. ⋯ There was no significant difference in pain scores experienced by patients undertaking ABG sampling with either a 23G or 25G needle.
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Review
BET 2: Does magnesium prolong the analgaesic effect of bupivacaine in a fascia iliaca nerve block?
A shortcut review was carried out to establish whether routine use of magnesium as an adjunct to bupivacaine fascia iliaca nerve block in femoral neck fracture was effective in prolonging its analgaesic effect. Forty-four papers were found using the reported searches, of which one 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 this paper are tabulated. It is concluded that while magnesium has the potential to prolong the analgaesic effect of bupivacaine further studies are needed to clarify its exact role and safety profile.
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Review
Near-infrared spectroscopy in the assessment of suspected sepsis in the emergency department.
The conventional approach to sepsis resuscitation involves early interventions targeting global oxygenation and macro-haemodynamic variables such as central venous and systemic arterial pressures. There is increasing recognition of the importance of microcirculatory changes in shock states, including sepsis, and the relationship of these to outcome. Near-infrared spectroscopy (NIRS) is a recently developed non-invasive technology that measures tissue oxygen saturations (StO2), which may be an indirect measure of the adequacy of the microcirculation. StO2 measurements, therefore, have the potential to identify patients who are at risk of progressing to organ dysfunction and could be used to guide resuscitation. This article reviews the current state of knowledge of NIRS in the setting of sepsis, examining its application, validity and prognostic value. ⋯ Outstanding questions still remain as to whether NIRS can help to risk-stratify patients with suspected sepsis in the emergency department and the utility of StO2 as a resuscitation target.
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Research addressing inequalities has focused predominantly on primary and community care; few initiatives relate to the pre-hospital environment. We aimed to identify in the literature barriers or facilitators experienced by patients from BME communities in accessing pre-hospital care and to explore the causes and consequences of any differences in delivery. ⋯ The paucity of literature and difficulties of transferring findings from US to UK context identified an important research gap. Further studies should be undertaken to investigate UK differences in prehospital care and outcomes for BME groups, followed by qualitative approaches to understand barriers and enablers to equitable access.