European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Review
Ultrasound-guided peripheral venous access: a systematic review of randomized-controlled trials.
To systematically review the current literature on the effect of using ultrasound (US) guidance for the placement of peripheral intravenous (PIV) catheters in patients with difficult access. ⋯ On the basis of this review, routine use of US guidance for PIV placement is not strongly supported by the literature.
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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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Mouth-to-mouth ventilation is often refused by laypersons because of hygienic reasons. Supraglottic airway devices (SADs) might reduce the adverse effects of mouth-to-mouth ventilation. We tried to verify the possibility for untrained laypersons to use SADs properly after having read written instructions only. ⋯ Time to ventilation was 124 s (±45 s) for the first attempt and 12 s (±2.75 s) for the second attempt. Delivering ventilation through an SAD is a reasonable way for laypersons. After a prior hands-on training, the placement can be performed in an adequate time frame with high success rates.
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The aim of this study was to analyze the current practices on acute pain management of patients under opioid maintenance treatment (OMT), that is, buprenorphine or methadone. A total of 706 physicians were solicited through a national network to answer a survey about pain perception and analgesic strategies. Among the prescribers, 323 (46%) answered the survey: 131 (40%) physicians estimated that patients under OMT when exposed to an acute painful event feel more pain than other patients and 170 (53%) estimated that the patients felt the same amount of pain. ⋯ Among the second-line analgesic drugs, the WHO step 3 analgesics (mainly morphine) were the most commonly reported [221 physicians (68%)]. Overall, the results demonstrate the misconceptions of physicians on the pain tolerance of patients under OMT. Clinical studies and evidence-based guidelines are necessary to improve the therapeutic strategies for such patients in an emergency setting.
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To derive and validate a new scoring system to predict in-hospital mortality in septic patients in the emergency department (ED). ⋯ The MISSED score should be used in the ED.