European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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A retrospective analysis of 118 trauma patients who underwent tracheostomy for airway and pulmonary management was undertaken. Timing of the procedure was defined as early (0-3 days), intermediate (4-7 days), and late (> 7 days). Head injury patients received tracheostomy early (p < 0.00003). ⋯ The incidence of pneumonia in the early group was not different from that observed in early extubated patients (n = 282; p < 0.23). Our study suggests that early tracheostomy may decrease pulmonary septic complications in trauma patients. Although no change in length of stay can be attributed to the early performance of tracheostomy, preventing pneumonia in the intensive care unit setting with its resulting high expense is beneficial.
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Ambulances in Taiwan have always been viewed by medical personnel and the population at large purely as transport vehicles. The emergency medical services (EMS) system upgrading will require a change of concept. Following emergency medical technicians (EMT) training in Keelung, a 400000-inhabitant mid-sized port city in northern Taiwan, we began prospective data collection to evaluate the patterns of ambulance use, misuse and potential needs within the community. ⋯ Despite low call volumes, misuse and non-transport, rates appear high. This is because the majority of accidents are called-in by passers-by who have no first aid training and a cultural aversion to becoming involved. At the same time unmet needs are also high, with education required to get the public to change their practice, and further study needed to see if this will, in fact, improve outcomes.
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Randomized Controlled Trial Clinical Trial
Administration of rectal indomethacin does not reduce the requirement for intravenous narcotic analgesia in acute renal colic.
The aim of this study was to compare the total dose of intravenous pethidine required to give satisfactory analgesia to patients with acute renal colic between two groups, one of which was also administered rectal indomethacin on presentation and one which was not. This was a prospective, randomized, unblinded comparison study. Each group contained 39 patients. ⋯ The primary endpoint was total pethidine dose required to achieve analgesia to the patient's satisfaction. No significant difference in total pethidine dose between the groups was found. It was concluded that administration of rectal indomethacin does not reduce the total dose of intravenous pethidine required to relieve the pain of acute renal colic.
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Jugular bulb oximetry provides the first bedside available information on cerebral oxygen utilization. An extensive analysis was made of all initial jugular bulb oximetry data obtained in 150 patients within the first 12 h after severe traumatic brain injury. ⋯ Jugular bulb desaturation was especially related to systemic causes (such as a lowered cerebral perfusion pressure observed in 29 patients, and a lowered arterial carbon dioxide tension in 24 patients). These findings could have important implications for the emergency management of severely head-injured patients, as outcome might possibly be improved by better attention to all systemic factors that might reduce cerebral perfusion in the early hours after traumatic insult.