European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Pyridoxine (vitamin B6) is a co-factor in many enzymatic pathways involved in amino acid metabolism: the main biologically active form is pyridoxal 5-phosphate. Pyridoxine has been used as an antidote in acute intoxications, including isoniazid overdose, Gyromitra mushroom or false morrel (monomethylhydrazine) poisoning and hydrazine exposure. It is also recommended as a co-factor to improve the conversion of glyoxylic acid into glycine in ethylene glycol poisoning. ⋯ The value of pyridoxine or its congener metadoxine as an agent for hastening ethanol metabolism or improving vigilance in acute alcohol intoxication is controversial. This paper reviews the various indications of pyridoxine in clinical toxicology and the supporting literature. The potential adverse effects of excessive pyridoxine dosage will also be summarized.
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Review
Is the management of dog bite wounds evidence based? A postal survey and review of the literature.
To determine current practice in the management of dog bite wounds with regard to the use of prophylactic antibiotics and primary closure and to compare the available evidence. ⋯ The management of recent dog bite wounds is not entirely evidence based in many A and E departments in the UK.
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Resuscitative mild hypothermia is and will increasingly be used in the emergency department as protection for the brain after an ischaemic insult. The clinical application of resuscitative mild hypothermia and its limitations will be summarized in this paper. The evidence for each application and its underlying mechanism will also be reviewed.
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A recent development in providing intensive care for children is that it is more and more centralized in tertiary centres. The centralization of intensive care facilities for children in tertiary centres demands a safe and well-organized transport system. The transfer of critically ill children from a referring general hospital to a tertiary paediatric intensive care centre should be performed by a specially trained and fully equipped transport team. ⋯ The minimal requirements of equipment and materials for transport that allow such care have been determined. The equipment consists of a monitor allowing continuous measurement of vital signs, a defibrillator, tools for airway and ventilatory management, an oxygen source, suction unit, fluid and electrolyte management, medication, resuscitation chart and a communication system. A mobile paediatric intensive care unit was constructed in order to store this equipment, including easily accessible ventilator and materials optimized for close patient observation and ventilator control.
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In the past two decades, emergency physicians have increasingly looked beyond their national borders to examine how emergency medicine is practised elsewhere in the world. A major result of their efforts is international emergency medicine, which can be defined as the area of emergency medicine concerned with the development and delivery of emergency medical care in the world. Several international trends are currently occurring in emergency medicine, including an increasing number of venues for information exchange, the spread of emergency medicine practice guidelines, an increasing number of international collaborations, and an increasing number of transnational special interest groups in emergency medicine. ⋯ Multiple challenges await those involved in international emergency medicine, including the need for internationally accepted definitions, a 'systems approach' to analysing emergency medicine systems, and more useful and affordable information. A related challenge is the need for effective consensus-based processes, including international standardization processes. Many of these challenges may be met through the effective leadership of international emergency medicine organizations.