Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2004
Clinical TrialA pilot trial of BIS monitoring for procedural sedation in the emergency department.
Procedural sedation is common in the ED. However, there is no objective physiologic parameter available to monitor a patient's conscious state. The Bispectral Index (BIS) monitor has been validated as an objective measure of depth of anaesthesia. We studied the BIS monitor for this role in procedural sedation. ⋯ BIS monitoring is feasible in the ED. Our small study suggests that there is a poor correlation between BIS values and the OAAS scale. Larger studies are required to further explore this relationship. Further developments in brain monitoring technology are also needed before this form of monitoring becomes clinically useful for procedural sedation.
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Emerg Med Australas · Apr 2004
The potential role of procalcitonin in the emergency department management of febrile young adults during a sustained meningococcal epidemic.
To prospectively investigate the diagnostic characteristics of procalcitonin as an aid in the diagnosis of meningococcal disease in febrile young adults presenting to the Waikato Hospital emergency department during a sustained meningococcal epidemic. ⋯ The finding of a procalcitonin level > or = 0.5 ng/mL in young adults with undifferentiated fever indicates an increased chance that the presenting illness may be meningococcal disease. In New Zealand's continuing meningococcal epidemic empirical antibiotics should be strongly considered in those with elevated procalcitonin levels in the hope of reducing meningococcal disease deaths due to delays in antibiotic administration.
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Emerg Med Australas · Apr 2004
Case ReportsCongenital diaphragmatic hernia masquerading as pneumonia.
Patients with congenital diaphragmatic hernia usually present in the immediate neonatal period with respiratory distress. However, presentation beyond the neonatal period has sporadically been reported. ⋯ Fortunately, after performing ultrasound, suspicion was raised and she was later diagnosed to have left congenital diaphragmatic hernia of Bochdalek type. Although rare, this entity should form one of the differential diagnoses of unresolving pneumonia in children.
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Emerg Med Australas · Apr 2004
Clinical TrialPracticality of performing medical procedures in chemical protective ensembles.
To determine whether certain life saving medical procedures can be successfully performed while wearing different levels of personal protective equipment (PPE), and whether these procedures can be performed in a clinically useful time frame. ⋯ A significantly greater time to complete procedures was documented in Level A PPE (fully encapsulated suits) compared with Levels C and D. There was however, no significant difference in times between Level B and Level C. The common practice of equipping hospital and medical staff with only Level C protection should be re-evaluated.
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Emerg Med Australas · Apr 2004
Clinical TrialProlonged pre-procedure fasting time is unnecessary when using titrated intravenous ketamine for paediatric procedural sedation.
Paediatric procedural sedation (PPS) is a common procedure in most general EDs. Many departmental guidelines suggest mandatory fasting times for children undergoing PPS, in an attempt to decrease the incidence of postoperative vomiting and (theoretically) aspiration pneumonitis, despite there being little or no evidence in the literature to support these mandatory fasting times. ⋯ Prolonged preprocedure fasting time did not reduce the incidence of postprocedure vomiting in this case series; to the contrary there was a increased incidence of vomiting with longer fasting times (P = 0.08). There was an increase in postprocedure vomiting with increasing age of the patients.