Emergency medicine journal : EMJ
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Randomized Controlled Trial Comparative Study
Comparison of powered and conventional air-purifying respirators during simulated resuscitation of casualties contaminated with hazardous substances.
Advanced life support of patients contaminated with chemical, biological, radiological or nuclear (CBRN) substances requires adequate respiratory protection for medical first responders. Conventional and powered air-purifying respirators may exert a different impact during resuscitation and therefore require evaluation. This will help to improve major incident planning and measures for protecting medical staff. ⋯ Powered air-purifying respirators improve the ease of breathing and do not appear to reduce mobility or delay treatment during a simulated resuscitation scenario inside an ambulance vehicle with a single CBRN casualty.
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Randomized Controlled Trial Comparative Study
Is it cost effective to introduce paramedic practitioners for older people to the ambulance service? Results of a cluster randomised controlled trial.
A scheme to train paramedics to undertake a greater role in the care of older people following a call for an emergency ambulance was developed in a large city in the UK. ⋯ Several changes in resource use are associated with the use of PP. Given these economic results in tandem with the clinical, operational and patient-related benefits, the wider implementation and evaluation of similar schemes should be considered.
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Randomized Controlled Trial Comparative Study
Comparison of bupivacaine and lidocaine with epinephrine for digital nerve blocks.
This study compared the efficacy in terms of pain of injection, time of onset and duration of action of digital blocks of bupivacaine 0.5% alone and lidocaine 1% with epinephrine (1:100,000). ⋯ Lidocaine (1%) with epinephrine (1:100 000) was significantly less painful and had a shorter duration of action than bupivacaine (0.5%), which had a similar onset of action for digital nerve block.
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Randomized Controlled Trial
The usefulness of the GlideScope video laryngoscope in the education of conventional tracheal intubation for the novice.
The aim of this study is to evaluate the usefulness of the GlideScope video laryngoscope (GVL) as a tool to educate novice users in conventional tracheal intubation. 41 premedical students with no previous experience in tracheal intubation participated in this prospective, randomised and controlled study. Group M (n = 20) was instructed in tracheal intubation by using the Macintosh laryngoscope and group G (n = 21) was instructed by using both the GVL and the Macintosh laryngoscope. ⋯ This aspect makes the trainee feel more comfortable learning the material with a high degree of satisfaction. Introducing GVL to conventional intubation education for novice users could increase the satisfaction of trainees during the procedure, especially as a way to understand critical anatomical structures.
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Randomized Controlled Trial
Cuffed oropharyngeal airway (COPA) placement is delayed by wearing antichemical protective gear.
Airway management, the first step in resuscitation, may entail special difficulties in mass casualty situations, even in experienced hands. Of the available airway devices, the cuffed oropharyngeal airway (COPA) appears the easiest one to insert, allowing a hands-free anaesthesiologist. A study was undertaken to evaluate the success of airway control with COPA when anaesthetists wore either surgical attire or antichemical protective gear. ⋯ Antichemical protective gear slowed proper placement of COPA and its fixation compared with surgical attire. COPA may be a temporarily useful device in non-conventional settings, but functional reassessment is required when injured patients reach medical facilities.