Emergency medicine journal : EMJ
-
Randomized Controlled Trial Clinical Trial
Sedation for children requiring wound repair: a randomised controlled double blind comparison of oral midazolam and oral ketamine.
To compare the efficacy of oral ketamine (10 mg/kg) with oral midazolam (0.7 mg/kg) in providing sedation for suturing of lacerations. ⋯ At these doses tolerance to LA injection was better in children receiving ketamine, with fewer behavioural changes noted in the first two weeks. Midazolam at this dose caused dysphoric reactions, which may have affected the results. Continuous pulse oximetry monitoring is required when using these drugs. Vomiting and prolonged ataxia occurred in a few patients.
-
Studies from the United States (US) suggest that using a chest pain observation unit (CPOU) saves from $567 to $2,030 per case compared with hospital admission. These savings will only be reproduced in the United Kingdom (UK) if the cost of routine hospital admission is similar. This study aimed to review current practice to determine the proportion of patients suitable for CPOU evaluation, the cost per case of routine admission and compare this with control groups in US studies. ⋯ Potential exists for the introduction of CPOU care to reduce health service costs in the UK. However, the magnitude of cost savings demonstrated in US studies were achieved by comparison to relatively high inpatient costs and should not be extrapolated. Economic evaluation of the CPOU should be repeated in the UK. The inclusion of interventional cardiology costs is an important determinant of cost effectiveness.
-
Advanced Trauma Life Support (ATLS) courses teach a system for the initial assessment and management of trauma patients that aims to optimise initial care and reduce mortality and morbidity, and have been adopted worldwide. This questionnaire survey characterised those who took up this particular educational resource in Scotland during a four year period after its introduction, and analysed how they felt it had affected their clinical competence. Irrespective of their previous level of training and experience, nearly all surgeons and anaesthetists who took this course felt that it had improved their clinical skills and other professional attributes. The significance of these results is discussed in the context of postgraduate surgical and anaesthetic training in Scotland.
-
A case is reported of the Lazarus phenomenon (the return of spontaneous circulation after cardiopulmonary resuscitation had been abandoned) in a patient following recreational drug use. The implications for management of cardiac arrest in the emergency department are discussed.