Open access emergency medicine : OAEM
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Open Access Emerg Med · Jan 2018
Prehospital dexamethasone administration in children with croup: a medical record review.
Croup is one of the most common childhood respiratory illnesses. Early dexamethasone administration in croup can improve patient outcomes. The objective of this study was to assess the clinical impact of prehospital administration of dexamethasone to children with croup. ⋯ Prehospital administration of dexamethasone results in less ED epinephrine use and may reflect dexamethasone's positive influence on the severity and short-term persistence of croup symptoms.
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Open Access Emerg Med · Jan 2018
ReviewThe role of inhaled methoxyflurane in acute pain management.
Methoxyflurane is an inhaled analgesic administered via a disposable inhaler which has been used in Australia for over 40 years for the management of pain associated with trauma and for medical procedures in children and adults. Now available in 16 countries worldwide, it is licensed in Europe for moderate to severe pain associated with trauma in conscious adults, although additional applications are being made to widen the range of approved indications. Considering these ongoing developments, we reviewed the available evidence on clinical usage and safety of inhaled analgesic methoxyflurane in trauma pain and in medical procedures in both adults and children. ⋯ Although two large retrospective comparative studies in the prehospital setting showed inhaled analgesic methoxyflurane to be less effective than intravenous morphine and intranasal fentanyl, this should be balanced against the administration, supervision times, and safety profile of these agents. Given the limitations of currently available analgesic agents in the prehospital and emergency department settings, the ease of use and portability of methoxyflurane combined with its rapid onset of effective pain relief and favorable safety profile make it a useful nonopioid option for pain management. Except for the STOP! study, which formed the basis for approval in trauma pain in Europe, and a few smaller randomized controlled trials (RCTs), much of the available data are observational or retrospective, and further RCTs are currently underway to provide more robust data.
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Open Access Emerg Med · Jan 2018
Potential mortality and cost reduction in adult severe sepsis and septic shock through the use of an innovative fluid delivery device.
While early fluid resuscitation has been shown to significantly improve health and economic metrics in septic shock, providers are often unable to achieve fluid delivery guidelines using current techniques. ⋯ Based on existing data supporting the importance of early, controlled fluid resuscitation in septic shock patients, the analytical model developed in this study demonstrated the benefit of a novel device that facilitates earlier fluid bolus completion and better adherence to sepsis bundles.
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Open Access Emerg Med · Jan 2018
Can base excess and anion gap predict lactate level in diagnosis of septic shock?
Lactate measurement is the key component in septic shock identification and resuscitation. However, point-of-care lactate testing is not widely used due to the lack of access to nearby test equipment. Biomarkers such as serum lactate, anion gap (AG), and base excess (BE) are used in determining shock in patients with seemingly normal vital signs. ⋯ In patients with septic shock, lactate and AG showed a strong correlation with each other, whereas lactate and BE showed a moderate correlation with each other. Thus, these biomarkers can be used interchangeably to help determine septic shock earlier in patients.
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Open Access Emerg Med · Jan 2018
Using initial serum lactate level in the emergency department to predict the sustained return of spontaneous circulation in nontraumatic out-of-hospital cardiac arrest patients.
To examine the initial level of lactate to predict sustained return of spontaneous circulation (ROSC) in nontraumatic out-of-hospital cardiac arrest (OHCA) patients. ⋯ The initial serum lactate had no association with sustained ROSC and hospital discharge with good neurological outcome but can be used to predict 24- and 48-hour postresuscitation mortality in nontraumatic OHCA patients with initial serum lactate cut-off points of 9.1 and 9.4 mmol/L, respectively.