J Emerg Med
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Intraosseous (IO) access in adults via the distal tibia has never been a widely accepted technique. Yet there have been occasional reports of the successful use of this procedure. This study was done to demonstrate the utility of IO infusions in the adult patient, including those patients in cardiac arrest. ⋯ This study shows that I. O. access can be quickly and easily obtained in adults in the medial supramalleolar position during cardiac arrest. This method of drug administration appears to hold promise as another useful modality for adults and older children during nontraumatic resuscitations.
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Animal laboratories have been used for many years to teach procedures. Our department has a weekly swine laboratory devoted to training residents, interns and students in resuscitative procedures. Physicians who participated in our swine procedure laboratory over the past three years were queried as to their prelaboratory and postlaboratory comfort levels with six different resuscitative procedures, and 57 (76%) physicians responded. ⋯ Of these responders, 62% offer an animal procedure laboratory. Overall, 97% of the residency directors rated the laboratory successful, and 97% of the residents rated the laboratory successful. Therefore, we conclude that an ongoing emergency medicine animal procedure laboratory is a valuable tool for improving physician-in-training ability and confidence.
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Emergency physicians regularly encounter patients who require local or topical anesthesia in the course of their emergency department (ED) treatment for lacerations, abrasions, or mucosal surface pain. Rarely, patients disclose a history of allergy to lidocaine and its chemical analogues, and the physician is faced with the problem of achieving adequate anesthesia without the use of these drugs. ⋯ Infiltration with a 1% diphenhydramine solution provided adequate anesthesia without noticeable adverse effects. We feel that diphenhydramine has a place in emergency medicine practice as a second-line local anesthetic agent.