Advanced emergency nursing journal
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Proximal femur fractures (PFF) are one of the many common injuries that present to the emergency department (ED). The current practice for pain management utilizes systemic opioid analgesics. The use of opioids is an excellent analgesic choice, but they carry a significant burden for potential adverse effects. ⋯ The use of femoral nerve blocks (FNBs) and fascia iliaca compartment blocks (FICB) are an alternative method of pain control in the ED. They have advantages over systemic opiates in that they do not require hemodynamic monitoring, have less adverse effects, and more importantly they induce rapid pain control with longer duration than systemic analgesics (). This manuscript examines a review of literature and identifies the efficacy, patient safety, indications, contraindications, patient satisfaction, and ultrasound-guided FNB and FICB techniques.
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The aim of this study was to explore the relationship between changes in prehospital blood pressure (BP) and the incidence of early neurological deterioration (END) after spontaneous intracerebral hemorrhage (SICH) in patients who arrive at the emergency department (ED) with a normal Glasgow Coma Scale (GCS) score. Records of consecutive adults with SICH transported by ambulance and treated in our ED from January 2015 to December 2017 were retrospectively reviewed. The study cohort included all patients with SICH occurring within the previous 6 hr who had a normal GCS score on ED arrival. ⋯ Factors associated with END on univariate analysis were regular antiplatelet agent use, shorter elapsed time, on-scene systolic blood pressure (SBP), prehospital SBP increase of 15 mmHg or more, intraventricular extension of the hematoma, and the presence of 3 or more noncontrast computed tomographic signs of hematoma expansion. After adjusting for other covariates, an increase in prehospital SBP of 15 mmHg or more was significantly associated with a higher risk of END. In patients with SICH who arrive at the ED with a normal GCS score, an increase in the prehospital SBP of more than 15 mmHg is associated with a higher incidence of END.