Emergency medicine journal : EMJ
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A shortcut review was carried out to establish whether routine use of bispectral index monitoring in emergency department conscious sedation was effective in improving patient safety. Thirteen unique 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 this paper are tabulated. It is concluded that there is currently insufficient evidence to support the routine use of bispectral index monitoring during conscious sedation and further studies are needed to investigate its exact benefits.
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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.