The American journal of emergency medicine
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Posterior hip dislocation is commonly seen in the emergency department and requires urgent reduction to help avoid complications. Many techniques have been described to perform the reduction, all aimed at helping the physician gain a mechanical advantage to overcome the bony anatomy and large muscles groups involved. ⋯ The lift is engaged to create the desired traction, allowing the provider to manipulate the hip with adduction/abduction and/or internal/external rotation to achieve reduction. In addition, our method may also allow the provider to task switch more easily between other requirements, such as procedural sedation and attention to the patient's airway, especially in the single coverage emergency department.
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Review Meta Analysis
Defibrillation strategies for patients with refractory ventricular fibrillation: A systematic review and meta-analysis.
The aim of this study was to summarize the existing evidence about the effectiveness of double defibrillation (DD) in comparison to standard defibrillation for patients with refractory ventricular fibrillation (RVF). DD encompasses double "sequential" external defibrillation (DSeq-D) and double "simultaneous" defibrillation (DSim-D), with the study also shedding light on the respective effects of DSeq-D and DSim-D. ⋯ The benefit of DSeq-D in survival to hospital discharge for RVF patients was found in the RCT, but not in cohort studies. Additionally, DSim-D should be applied with greater caution for RVF patients. Further validation is needed through larger-scale and higher-quality trials.
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Randomized Controlled Trial Multicenter Study Comparative Study
Alfentanil versus fentanyl for emergency department rapid sequence induction with ketamine: A-FAKT, a pilot randomized trial.
Fentanyl is often administered during rapid sequence induction of anesthesia (RSI) in the emergency department (ED) to ameliorate the hypertensive response that may occur. Due to its more rapid onset, the use of alfentanil may be more consistent with both the onset time of the sedative and the commencement of laryngoscopy. As such, we compared the effect of alfentanil and fentanyl on post-induction hemodynamic changes when administered as part of a standardized induction regimen including ketamine and rocuronium in ED RSI. ⋯ Alfentanil and fentanyl produced comparable post-induction hemodynamic changes when used as adjuncts to ketamine in ED RSI. Future studies could consider comparing different dosages of these opioids.