Emergency medicine journal : EMJ
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Randomized Controlled Trial Comparative Study
Impact of oral dexamethasone versus placebo after ED treatment of migraine with phenothiazines on the rate of recurrent headache: a randomised controlled trial.
Evidence suggests that the rate of recurrent headache after treatment of migraine in the emergency department (ED) is high. The mechanisms for this are unclear, but neurogenic inflammation may play a role. There is conflicting evidence about whether adjuvant dexamethasone reduces the rate of recurrent headache. The aim of this study was to compare the rate of recurrent headache in patients with migraine randomised to receive a single dose of oral dexamethasone or placebo at discharge after treatment in the ED with intravenous phenothiazine. ⋯ A single oral dose of dexamethasone following phenothiazine treatment for migraine in the ED did not reduce the rate of recurrent headache. There is weak evidence for a possible benefit in the subgroup who present within <24 h of symptom onset. A multicentre trial to confirm this finding is warranted.
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Consultation is a common and important aspect of emergency department (ED) practice which can lead to delays in patient flow. Little is known about ED consultations and this review systematically evaluated the literature on ED consultations. ⋯ Consultation research in the emergency setting is limited and variable; however, high consultation rates exist in some centres. This systematic review outlines the current state of the literature and suggests that further research is urgently needed.
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Randomized Controlled Trial Comparative Study
Retention of mouth-to-mouth, mouth-to-mask and mouth-to-face shield ventilation.
Retention of mouth-to-mouth, mouth-to-mask and mouth-to-face shield ventilation techniques is poorly understood. ⋯ One year after a single episode of ventilation training, lay persons tended to hyperventilate; however, the degree of hyperventilation and resulting stomach inflation were lower when a mouth-to-mask or a face shield device was employed. Regular training is therefore required to retain ventilation skills; retention of skills may be better with ventilation devices.
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To establish the size of the population of patients presenting to a UK emergency department (ED) with systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock and to determine their mortality and length of stay. ⋯ The high incidence of severe sepsis and septic shock with its attendant high mortality and length of stay is highlighted. If the figures are annualized, this would equate to 650 cases of severe sepsis or septic shock, of which 169 would die. The ED is well placed to improve this outcome by earlier detection and the use of goal directed therapy.
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Controlled Clinical Trial
A novel method to assist nasogastric tube insertion.
It can sometimes be difficult to insert a nasogastric tube (NGT) in a patient in whom intubation has been performed. Because of the patient's inability to swallow and the presence of the inflated cuff of the endotracheal tube, the NGT will often become coiled in the oral cavity. A previous study showed that rigid tubes require fewer insertion attempts than flexible tubes. An attempt was therefore made to increase the rigidity of NGTs by filling the tube with water (water-fill method). The objective of this study was to investigate whether water-filled NGTs would facilitate tube insertion. ⋯ The water-fill method is a simple and fast method to facilitate NGT insertion in intubated patients.