European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study
Intubation by paramedics using the ILMA or AirTraq, KingVision, and Macintosh laryngoscopes in vehicle-entrapped patients: a manikin study.
Four devices were compared in a simulated scenario of a vehicle-entrapped patient: standard Macintosh laryngoscope, intubating laryngeal mask (ILMA), AirTraq optical laryngoscope, and KingVision videolaryngoscope. A group of 30 final-year paramedic students intubated a manikin placed in a sitting position under a desk simulating the roof of a car. ⋯ The mean time to intubation was 13.9±6.6, 24.7±4.7, 25.2±3.7, and 23.9±4.2 s; the first attempt success ratios for devices were 29/30, 18/30, 6/30, and 18/30; and the baseline time of intubation was 14.3±6.5, 16.7±4.7, 22.9±12.6, and 18.1±5.0 s for ILMA, Macintosh laryngoscope, Airtraq, and KingVision, respectively. In emergency situations with very limited access to the patient, ILMA is the most effective device for intubation by paramedics.
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Comparative Study Observational Study
Can a change in pH and pCO2 be used to monitor progress in patients undergoing noninvasive ventilation? A prospective cohort study.
The aim of this study was to compare changes in arterial and venous pH and pCO2 in patients undergoing noninvasive ventilation and having serial blood gases to assess ventilatory function. This was a prospective observational study of patients with acute respiratory distress. The outcome of interest was agreement in change in pH and pCO2 between arterial and venous specimens [mean difference; 95% limits of agreement (LoA)]. ⋯ The agreement between absolute change is reasonable for pH but not for pCO2. The direction of change agreed in most cases. Changes in venous pH and pCO2, in combination with clinical assessment, may be useful for assessing progress in patients undergoing noninvasive ventilation.
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To investigate the prevalence, etiology, and symptoms of severe hypokalemia in patients presenting to the emergency department. ⋯ Hypokalemia is common in the emergency department. Severe hypokalemia is often symptomatic and more than two-thirds of patients show ECG changes.
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Adverse drug reactions (ADRs) to N-acetylcysteine (NAC) treatment for paracetamol overdose are typically anaphylactoid in origin and occur in 2-48% of treated patients. We explored the incidence and management of NAC ADR in our unit. ⋯ The incidence of ADR to NAC was comparable with published studies, although there was no association of severity with asthma or female sex. The management of ADRs is variable, with frequent, inappropriate use of steroids. Education about the pathophysiology of these ADRs may improve management.
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The objective of this study was to analyse the use of lights and siren (L&S) during transport to the hospital by the prehospital severity status of the patient and the time saved by the time of day of the mission. ⋯ At present, the use of L&S seems questionable given the severity status or NACA score of transported patients. Our results should prompt the implementation of more specific regulations for L&S use during transport to the hospital, taking into consideration certain physiological criteria of the victim as well as time of day of transport.