Emergency medicine Australasia : EMA
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Emerg Med Australas · Aug 2009
What is the nature of the emergence phenomenon when using intravenous or intramuscular ketamine for paediatric procedural sedation?
Ketamine has become the drug most favoured by emergency physicians for sedation of children in the ED. Some emergency physicians do not use ketamine for paediatric procedural sedation (PPS) because of concern about emergence delirium on recovery. The present study set out to determine the true incidence and nature of this phenomenon. ⋯ The belief that ketamine, in the doses used for ED PPS, causes frequent emergence delirium is flawed. A pleasant emergence phenomenon is common, but is not distressing for the child, and has no long-term (up to 30 days) negative sequelae. Rarely, there is anxiety or distress on awakening from ketamine sedation, which settles spontaneously. This should not deter emergency physicians from using ketamine for PPS.
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Emerg Med Australas · Aug 2009
Clinical TrialConfirmation of endotracheal intubation by combined ultrasonographic methods in the Emergency Department.
The objective of the present study was to investigate whether the combined use of transcricothyroid membrane ultrasonography and ultrasonographic evaluation for pleural sliding is useful for verifying endotracheal intubation in the ED. ⋯ The combination of transcricothyroid membrane ultrasonography and ultrasonographic lung-sliding evaluation could be useful in confirming endotracheal intubation in the ED.
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Emerg Med Australas · Aug 2009
Emergency Department management of Colles-type fractures: a prospective cohort study.
To assess radiographic outcomes from ED reduction of Colles-type fractures. ⋯ The study highlights the importance of the initial 'on arrival' and 'post-reduction' X-rays in the ED. Displaced fractures are more likely to go onto poor outcome, as are inadequately reduced fractures. Medical officers working in ED should be aware of the importance of measuring the dorsal angle. They should be referring patients with >15 degrees dorsal angulation to orthopaedics early. Reduction should not be accepted until the dorsal angle has been adequately corrected.
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Emerg Med Australas · Aug 2009
Validation of a point of care troponin assay in real life Emergency Department conditions.
To validate the accuracy of a Point of care (POC) troponin device (Abbott i-Stat) in real life ED conditions. ⋯ The i-Stat POC device produces similar results in the hands of experienced and occasional operators in ED. There is good agreement between the POC and laboratory at levels used to diagnose infarction by older, more specific criteria. When compared using new lower cut-offs, the i-Stat had poor sensitivity.