European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The objective of the study was to describe a five-step protocol for withholding and withdrawing of life support (WH/WDLS) in an emergency department (ED) for terminally ill patients. ⋯ This five-step protocol could improve collaboration in the WH/WDLS decision-making process, while facilitating dialogue and transmission of information between staff and families.
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The objective of the report was to study the efficacy and safety of ketamine and midazolam combination in the procedural sedation of incision and drainage of abscesses in the adult emergency department (ED) patients. This prospective observational study enrolled patients aged 16-60 years (American Society of Anesthesiologists class I) requiring abscess drainage in an adult ED. Patients received 2 mg/kg of ketamine infusion over 5 min and midazolam 2-5 mg titrated to deep sedation according to Ramsay sedation scale. ⋯ The median time for blood pressure and pulse rate to return to baseline was 20+/-2.7 min. The use of ketamine and midazolam sedation is both well tolerated and effective for adults in the ED undergoing incision and drainage of abscesses. This study is limited by the small sample size.
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Carbon monoxide (CO) is a colorless, odorless and nonirritating gas. CO poisoning is a preventable cause of morbidity and mortality. After the late diagnosis of some CO-poisoned patients, we undertook a chart review to identify characteristics of patients with CO poisoning to help with management of future patients. ⋯ CO exposure in our patients was acute, accidental, and occurred during the winter months. Serious symptoms, such as syncope, occurred more often in patients having increased COHb levels, but normal COHb levels could not be used to rule out CO poisoning.
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Organizations involved in disaster response often have a defined operative level of management (command and control) that can take the overall decisions regarding the mobilization and distribution of resources and distribution of casualties. This level of management can be referred to as strategic management. The aim of this pilot study was to show the possibility, in simulation exercises, to relate decisions made regarding resources to patient outcome. ⋯ The pilot study demonstrated the possibility to, in simulation exercises, relate decisions made regarding resources to patient outcome. This training technique could possibly lead to increased knowledge in what decisions are crucial to make in an early phase to minimize mortality and morbidity.
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We encountered a case whereby an 18-year-old boy presented to the Emergency Department with a stab wound to the left posterior chest. Chest X-ray (CXR) showed what appeared to be a pneumothorax and chest drain insertion was considered. It was confirmed subsequently that this apparent pneumothorax was due to a linear artefactual projection from the edge of the oxygen mask reservoir bag. We set out to investigate whether our colleagues would have misdiagnosed this artefact and what their initial treatment plan would have been. ⋯ Our results show that almost half of our colleagues would have carried out tube thoracostomy when no pneumothorax was actually present. In a situation where a pneumothorax is a clinical possibility we would recommend either temporarily removing the oxygen mask if clinically stable, or fixing the reservoir bag outwith the field of the CXR by means of adhesive tape to avoid any misinterpretation of this 'mask sign'.