European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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According to the WHO, the yearly national consumption of opioids is one indicator of a country's investment on relieving moderate-to-severe pain. We implemented guidelines for treatment of pain in our emergency department (ED) and tracked the major analgesics used in this ED to monitor trends in pain management over a decade. The study was carried out in a Level I trauma center ED. ⋯ Meperidine use did not change. In conclusion, our ED patients are now generally receiving more analgesics than 10 years ago. Electronically stored data on analgesics are accurate and easily accessible for tracking the nature and quantity of prescriptions, but not for correlating their association with patient outcome.
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Clinical Trial
Initial ventilation through laryngeal tube instead of face mask in out-of-hospital cardiopulmonary arrest is effective and safe.
Bag-valve-mask ventilation is recommended as the initial airway management option for paramedics during cardiopulmonary resuscitation, although this technique requires considerable skill and is associated with the risk of stomach insufflation, regurgitation, and aspiration. The present two-phase study investigated the efficacy and safety of the laryngeal tube (LT-D) used by paramedics as the sole technique for ventilation in out-of-hospital cardiac arrest. ⋯ The LT-D is feasible and effective for airway management and ventilation when used by paramedics in out-of-hospital cardiopulmonary resuscitation and can be recommended as the sole technique in such situations.
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The objective of this audit was to evaluate the impact of brief educational intervention on prompt recognition and treatment of pain in the emergency department. The audit was performed on all patients in the emergency department with pain presenting over a 24-h period on three occasions: preintervention, 1-week postintervention and at 4 months. In 151 patients, pain severity scores were mild (24%), moderate (42%), severe (16%) and unknown (18%). ⋯ There was no significant difference in the number of patients treated within 20 min for severe pain (P = 0.076) and within 60 min for moderate pain (P = 0.796) between audits. The likelihood of receiving analgesia within 20 min increased with the patients' pain category (relative risk: 1.8 95% confidence interval: 1.4-2.3). Documentation of pain assessment and the use of pain scores at triage improved after a brief educational intervention but there was no measurable impact on treatment times.
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This study assessed the time it takes for newly trained basic life-support/automated external defibrillator (BLS/AED) providers to complete five cycles of cardiopulmonary resuscitation (CPR) and whether it is easier to follow a 2-min time frame or to count five cycles of CPR. Then, it assesses how many chest compressions are delivered with each of the two methods and the time needed to deliver the first two rescue breaths. Eighty BLS/AED providers were asked to provide 2 min of CPR with a compression-ventilation ratio of 30:2 and at a compression rate of 100/min without looking at any timing device and then to provide five cycles of CPR with the same compression-ventilation ratio. ⋯ Sixty-two participants (77.5%) found it easier to count five cycles of CPR. The time needed to deliver the first two rescue breaths was between 12 and 15 s. The average time to complete five cycles of CPR is approximately 2 min for newly trained BLS/AED providers and the majority of the participants found it easier to perform five cycles.