Emergency medicine journal : EMJ
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Randomized Controlled Trial
Is there an optimal place for holding the tracheal tube during intubation? A proof-of-concept randomised clinical trial.
The optimal way to hold an endotracheal tube (ETT) during intubation has not been studied. In this randomised clinical trial, we examined the effect of site-holding the ETT in two different positions on time and ease of intubation by anaesthesia trainees. ⋯ In stable patients with uncomplicated airways, there was no significant difference in TTI based on the site at which trainees were assigned to hold the ETT. However, the shorter TTI at 24 cm in per-protocol analysis and fewer sore throat observed suggest this practice change warrants further investigation.
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The NHS has the target of reducing its carbon emission by 80% by 2032. Part of its strategy is using pharmaceuticals with a less harmful impact on the environment. Nitrous oxide is currently used widely within the NHS. Nitrous oxide, if released into the atmosphere, has a significant environmental impact. Methoxyflurane, delivered through the Penthrox 'green whistle' device, is a short-acting analgesic and is thought to have a smaller environmental impact compared with nitrous oxide. ⋯ This LCIA has shown that the overall 'cradle-to-grave' environmental impact of Penthrox device is better than nitrous oxide when looking specifically at climate change impact. The climate change impact for an equivalent dose of intravenous morphine was even lower. Switching to the use of inhaled methoxyflurane instead of using nitrous oxide in certain clinical situations could help the NHS to reach its carbon emission reduction target.
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Nitrous oxide (N2O) has multiple benefits in paediatric procedural sedation (PPS), but use is restricted by its limited analgesic properties. Analgesic potency could be increased by combining N2O and intranasal fentanyl (INF). We assessed safety and efficacy data from 10 years (2011-2021) of our N2O PPS programme. ⋯ N2O can provide effective PED PPS. No SAEs were recorded. INF may be an effective PPS adjunct but remains limited by increased rates of vomiting.
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Prior reports describe the care children receive in community EDs (CEDs) compared with paediatric EDs (PEDs) as uneven. The Emergency Medical Services for Children (EMSC) initiative works to close these gaps using quality improvement (QI) methodology. Project champion from a community hospital network identified the use of safe pharmacological and non-pharmacological anxiolysis and analgesia (A&A) as one such gap and partnered with EMSC to address it. ⋯ ED LOS was unchanged, and the perceptions of provider's A&A knowledge, attitudes and practice patterns improved. A CED-initiated QI project increased paediatric A&A use in a CED network. An A&A toolkit outlines our approach and may simplify spread from academic children's hospitals to the community.