Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2011
Randomized Controlled TrialEquivalency of two concentrations of fentanyl administered by the intranasal route for acute analgesia in children in a paediatric emergency department: a randomized controlled trial.
Intranasal fentanyl's (INF) effectiveness is established using highly concentrated INF (HINF). Standard concentration INF (SINF) is more widely available. We aimed to illustrate the equivalence of SINF to HINF. ⋯ The two concentrations of INF were equivalent in reducing pain, with a trend to increased oral additional agents in the more dilute solution. The widespread use of this readily available analgesic in the standard concentration can be supported, particularly in patients <50 kg.
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Emerg Med Australas · Apr 2011
Case ReportsPneumocephalus and Brown-Sequard syndrome caused by a stab wound to the back.
This report describes a case of Brown-Sequard syndrome in a man who presented to the ED after a stabbing to the left scapula region. The incidental finding of pneumocephalus found on CT scan during workup lead to cervical MRI that revealed the spinal cord pathology associated with Brown-Sequard syndrome.
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Emerg Med Australas · Apr 2011
ReviewIntravenous lipid emulsion as antidote: a summary of published human experience.
Intravenous lipid emulsion (ILE) has been demonstrated to be effective in amelioration of cardiovascular and central nervous system sequelae of local-anaesthetic and non-local-anaesthetic drug toxicity in animal models. Sequestration of lipophilic toxins to an expanded plasma lipid phase is credited as the predominant beneficial mechanism of action of ILE. Systematic review of published human experience is however lacking. ⋯ Forty-two cases of ILE use (19 local-anaesthetic, 23 non-local-anaesthetic) were identified, with anecdotal reports of successful resuscitation from cardiovascular collapse and central nervous system depression associated with ILE administration in lipophilic toxin overdose. Although significant heterogeneity was observed in both agents of intoxication, and reported outcomes; case report data suggest a possible benefit of ILE in potentially life-threatening cardio-toxicity from bupivacaine, mepivacaine, ropivacaine, haloperidol, tricyclic antidepressants, lipophilic beta blockers and calcium channel blockers. Further controlled study and systematic evaluation of human cases is required to define the clinical role of ILE in acute poisonings.
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Emerg Med Australas · Apr 2011
Simple clinical targets associated with a high level of patient satisfaction with their pain management.
We aimed to determine factors that are significantly associated with a high level of patient satisfaction with their pain management. ⋯ Our 'adequate analgesia' definition might provide a useful clinical target, which, combined with adequate communication, might help maximize patient satisfaction.