Emergency medicine journal : EMJ
-
Cannulation of children is often required for administration of intravenous fluids and medications, but can cause pain and anxiety. Amethocaine and a eutectic mixture of local anaesthetics (EMLA) cream are two of the most commonly used local anaesthetic creams. ⋯ Based on the evidence reviewed here and considering analgesic properties and cost-savings associated with both creams, a weak recommendation can be issued in favour of Amethocaine cream for cannulation in children based on high-quality evidence but where the treatment choice will depend on other factors including cost and provider preference.
-
Randomized Controlled Trial
Over-the-head two-thumb encircling technique as an alternative to the two-finger technique in the in-hospital infant cardiac arrest setting: a randomised crossover simulation study.
To determine if the over-the-head two-thumb encircling technique (OTTT) provides better quality cardiopulmonary resuscitation (CPR) than the conventional two-finger technique (TFT) when performed by a lone rescuer in an in-hospital infant cardiac arrest setting. ⋯ OTTT performed by a lone rescuer in an in-hospital infant cardiac arrest setting resulted in greater compression depth, with no increase in hands-off time, compared with TFT. OTTT may therefore be a suitable alternative to TFT in the in-hospital infant cardiac arrest setting.
-
Review Case Reports
BET 2: The use of age-related D-dimers to rule out deep vein thrombosis.
A short cut review was carried out to establish whether the use of age-adjusted D-dimer cut-offs is better than the standard, unadjusted diagnostic cut-off for excluding the diagnosis of deep vein thrombosis (DVT) in the Emergency Department. Three studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that the use of an age-adjusted D-dimer cut-off in patients aged over 50 years increases the ability to safely exclude DVT in patients with low clinical probability without the need for ultrasound scanning.
-
Randomized Controlled Trial Comparative Study
Randomised trial of the fascia iliaca block versus the '3-in-1' block for femoral neck fractures in the emergency department.
Femoral neck fractures are a common and painful injury. Femoral nerve blocks, and a variant of this technique termed the '3-in-1' block, are often used in this patient group, but their effect is variable. The fascia iliaca compartment block (FIB) has been proposed as an alternative, but the relative effectiveness of the two techniques in the early stages of care is unknown. We therefore compared the FIB versus the 3-in-1 block in a randomised trial conducted in two UK emergency departments. ⋯ FIB is equivalent to the 3-in-1 block for immediate pain relief in adult neck of femur fractures.
-
High utilisation of emergency department (ED) among the elderly is of worldwide concern. This study aims to review the effectiveness of interventions targeting the elderly population in reducing ED utilisation. ⋯ The investigated interventions have mixed effectiveness. Our findings suggest the hospital-based interventions have relatively poorer effects, and should be better connected to the community-based strategies. Interventions seem to achieve the most success with integration of multi-layered elements, especially when incorporating key elements such as a nurse-led multidisciplinary team, integrated social care, and strong linkages to the longer-term primary and community care. Notwithstanding limitations in generalising the findings, this review builds on the growing body of evidence in this particular area.