European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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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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Multicenter Study
Emergencies related to cocaine use: a European multicentre study of expert interviews.
Illicit drug use can lead to acute reverse reactions leading to the admission to emergency departments. Cocaine-related emergencies have been monitored in the USA, but not in Europe so far. The study investigates patterns of cocaine emergencies in eight European cities in a multicentre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Rome, Vienna and Zurich. ⋯ Patterns of complaints among cocaine users are associated with the psychomotor-stimulant or cardiovascular effects of cocaine. Urine screens and referrals to the addiction services are infrequent. A closer link between the emergency departments and addiction services would help in guiding problematic drug users towards appropriate treatment at an earlier stage in the addiction process.
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This study's objective was to ascertain emergency department (ED) patient preferences for pain assessment frequency. This was a prospective, convenience-sample trial of all-diagnosis adults with pain at least 3/10, in an academic ED (census 90 000). Using a computer-based automated pain tracker, patients entered initial pain level and indicated how frequently they wanted pain assessed. ⋯ Regression was used to assess relationships between patient factors and the endpoint 'frequency of preferred pain assessment.' There was no association between initially suggested time interval (median, 15 min) and sex (P = 0.455), race (P = 0.976), age (P = 0.391), or in-room visitors (P = 0.956). Pain severity was associated with preference for more frequent pain assessment (P = 0.009). ED patients' preference for pain assessment is approximately 15 min, with more frequent intervals preferred when pain is severe.
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We report the case of a 72-year-old lady who presented to our institute with acute pancreatitis. Seven days later, she experienced an acute episode of chest pain associated with the pronounced electrocardiographic changes and elevated cardiac enzymes. Although subsequent coronary angiography was normal, a left ventriculogram demonstrated a marked area of apical akinesia and hyperkinesia of the basal left ventricular walls. We believe this to be the first case of pancreatitis induced takotsubo cardiomyopathy in the international literature.
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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.