European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Pediatric emergency medicine (PEM) has been developing rapidly but heterogeneously in many European countries in recent years, and many national PEM societies have been founded to improve the quality of care of ill and injured children and adolescents. Key facets of any such improvement are the development, delivery and translation of high-quality research. ⋯ Multicentre research carried out in this way will bring about improvements in the quality of emergency care for children in European emergency departments, and result in a better quality of life for children and adolescents. This paper outlines the background and achievements of REPEM to date and describes the current structure and next steps.
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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.