Emergency medicine journal : EMJ
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Review Comparative Study
Midazolam or ketamine for procedural sedation of children in the emergency department.
A short cut review was carried out to establish whether ketamine or midazolam is superior at providing safe and effective conscious sedation in children in the emergency department. A total of 203 papers were found using the reported searches, of which four presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are summarised in table 1. It is concluded that midazolam and ketamine have similar efficacy and safety profiles but that ketamine is preferred by parents and physicians.
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Randomized Controlled Trial Comparative Study
Tracheal intubation by non-anaesthetist physicians using the Airway Scope.
To evaluate the performance of the Airway Scope for tracheal intubation by non-anaesthetist physicians. ⋯ The Airway Scope may reduce the time to secure the airway and the incidence of failed tracheal intubation in novice laryngoscopists.
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Comparative Study
Short stay emergency admissions to a West Midlands NHS Trust: a longitudinal descriptive study, 2002 2005.
To describe changes and characteristics in emergency admissions to a West Midlands National Health Service Trust, 2002-2005, with a focus on short stay emergency admissions. ⋯ Increases in emergency admissions were greater in short stay than long stay cases. Reasons for this may be both appropriate (increased use of clinical protocols and falling average length of stay) and detrimental (pressure to meet 4 h emergency department target, changing primary care provision). Further research is needed before generalising findings to other Trusts.
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Comparative Study
Comparison of arterial and venous pH, bicarbonate, PCO2 and PO2 in initial emergency department assessment.
To determine the agreement between arterial and venous samples in a pathologically diverse patient population presenting at an emergency department (ED) with a view to obviating the need for arterial blood gas (ABG) analysis in initial ED evaluation. ⋯ Venous blood gas analysis for pH, bicarbonate and Pco(2) may be a reliable substitute for ABG analysis in the initial evaluation of an adult patient population presenting to the ED.
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Comparative Study
Use of the prehospital ECG improves door-to-balloon times in ST segment elevation myocardial infarction irrespective of time of day or day of week.
The use of the prehospital electrocardiogram (ECG) to identify patients with ST-segment elevation myocardial infarction (STEMI), coupled with a centralised system to alert the cardiac catheterisation team in preparation for prompt intervention, has been shown to reduce door-to-balloon times (DBT) effectively. A confounding variable in prolonging the recommended 90 min DBT is the time of day or day of the week of patient presentation. We postulated that use of the prehospital ECG, coupled with an emergency department initiated "Cath Alert" system, could neutralise DBT delays related to time of day or day of week. ⋯ Variables such as time of day and mode of presentation have an impact on achieving currently recommended DBT in patients with STEMI. With the addition of each prehospital variable in succession-that is, arrival by emergency medical services, Cath Alert system, and the prehospital ECG-the DBT can be progressively shortened and the adverse "off hour effect" nullified.