European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study
A cadaveric study of complications associated with the subxiphoid and transthoracic approaches to emergency pericardiocentesis.
The aim of this cadaveric study was to compare three commonly used approaches for emergency pericardiocentesis and to determine the safest approach. ⋯ The SXP1 approach appeared to be the safest, followed by anterior transthoracic intercostal pericardiocentesis. The SXP2 approach caused the highest amount of complications, resulting from the needle entering the abdominal cavity. The presence of intra-abdominal pathology and the possibility of post-mortem changes in the position of the diaphragm, however, might have been a causative factor in this finding.
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Letter Case Reports
Analgesia and sedation in the presence of a naltrexone implant: a novel pharmacological challenge.
In chronic opioid abusers, sedation and analgesia present challenges. We describe two trauma patients with naltrexone implants (depot micro-receptor antagonists that facilitate opioid withdrawal) requiring intensive care. The first patient, a 28-year-old man, sustained chest and pelvic injuries when hit by a motor vehicle. ⋯ Propofol, tramadol and paracetamol proved effective. We wish to notify colleagues of the existence of these implants as they are increasingly widely used, and should be considered when encountering severe opioid resistance. Secondly, their role in managing opioid-dependent physicians appears promising.
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The paper refers to the problem of emergency medical service in Poland, which is the only European Union Member State not having activated the emergency phone number 112. This fact has caused the threat of European Union sanctions. ⋯ The necessary law was enacted in 2001, but it did not come into force. The threat of European Union sanctions may hasten its implementation; however, the weak position of the present government may cause a further delay of the reform.
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Multicenter Study
Low molecular weight heparin self-injection training: assessment of feasibility, tolerance and economic analysis in emergency departments.
The purpose of this study was to assess low molecular weight heparin auto-injection skills of self-supporting patients, taught by a nurse through a rapid demonstration in an emergency department. ⋯ It seems possible to extend the practice of self-injection to other types of injections prescribed after discharge from the emergency department, such as preventive low molecular weight heparin for surgical or medical purposes and curative ambulatory low molecular weight heparin treatment for deep vein thrombosis.
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Review
Prehospital evaluation and treatment of a presumed acute coronary syndrome: what are the options?
The earlier infarct-limiting therapy is started the better is the outcome among patients suffering from a threatened myocardial infarction. The introduction of a prehospital electrocardiogram has improved triage of patients with acute chest pain. ⋯ Other treatments of potential value in the prehospital setting are oxygen, narcotic analgesics, nitrates, aspirin, heparin, low molecular weight heparin, glycoprotein IIB, IIIA blockers, clopidogrel and beta-blockers. We need further studies, however, for most of these treatments including cost-benefit analysis, analysis of various logistic aspects and safety in order to confirm their value.