International journal of emergency medicine
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Over the last decade, the diffusion of ultrasound technology to nontraditional users has been rapid and far-reaching. Much research and effort has been focused on developing an ultrasound curriculum and training and practice guidelines for these users. The potential for this diagnostic tool is not limited to the developed world and in many respects ultrasound is adaptable to limited resource international settings. However, needs-based curriculum development, training guidelines, impact on resource utilization, and sustainability are not well studied in the developing world setting. ⋯ While ultrasound as a diagnostic modality for resource-poor parts of the world has generated interest for years, recent advances in technology have brought ultrasound again to the forefront as a sustainable and high impact technology for resource-poor developing world nations. From our experience in rural Rwanda, we conclude that ultrasound remains helpful in patient care and the diagnostic impact is enhanced by choosing the correct applications to implement. We also conclude that ultrasound is a teachable skill, with a several week intensive training period involving hands-on practice skills and plans for long-term learning and have begun a second phase of evaluating knowledge retention for this introductory program.
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Although young age is considered a risk factor for adverse events related to procedural sedation and analgesia (PSA), data in very young children (<2 years of age) are lacking. ⋯ Our data suggest that children under 2 years of age can be sedated effectively without increased risk of AE in a PED.
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Research on cardiac resuscitation has led to various changes in the techniques and drug administration involved in modern advanced life support. Besides improving primary cardiac survival, interest is increasingly focused on a favourable neurological outcome. However, until now there has been no on-site equipment to support the clinical observations of the cardiopulmonary resuscitation (CPR) team. ⋯ While the first cardiac resuscitation was survived without neurological consequences, the patient died after the second event. Both resuscitation events were monitored using the BIS. We discuss the course of BIS values and their possible contribution to the prediction of outcome.
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One of the highest rates of illicit cocaine consumption in Europe is in Spain. Our objective was to study the incidence and impact of undisclosed cocaine consumption in patients attending the emergency department (ED) for trauma or chest pain. ⋯ Thirty percent of eligible patients participated. Of 75 cases, 61.3% had trauma and 38.7% chest pain; 25% presented a positive test for drugs. Cocaine was present in 13.3% and cannabis in the same proportion. No differences were found regarding positive cocaine test and chief complaint, ED or hospital stay, or additional tests. Cocaine-positive patients were significantly younger.