International journal of emergency medicine
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Electrolyte values are measured both by arterial blood gas (ABG) analyzers and central laboratory auto-analyzers (AA), but a significant time gap exists between the availability of both these results, with the ABG giving faster results than the AA. The authors hypothesized that there is no difference between the results obtained after measurement of electrolytes by the blood gas and auto-analyzers. ⋯ Based on the above analysis, the authors found no significant difference between the potassium values measured by the blood gas machine and the auto-analyzer. However, the difference between the measured sodium was found to be significant. We therefore conclude that critical decisions can be made by trusting the potassium values obtained from the arterial blood gas analysis.
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The purpose of this study was to evaluate the effectiveness of a new, fixed, yet individualized dosing regimen of activated prothrombin complex concentrate factor VIII inhibitor bypassing activity (FEIBA) for warfarin reversal in the setting of a life-threatening bleeding in a secondary care center. ⋯ The presented dosing regimen results in safe reversal of warfarin-induced coagulopathy, which appears to be faster and more profound than following FFP. Moreover, the use of activated PCC (FEIBA) does not appear to carry an increased risk of thrombotic events when compared to the rate reported for several non-activated PCC preparations.
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Vascular access is a critical skill for emergency physicians. However, it can be unpredictably challenging in some patients. While ultrasound-guided vascular access has been encouraged in emergency departments, there have been few studies evaluating echo-enhanced needles and their usefulness in performing vascular access. ⋯ Echo-enhanced needles did not provide objective performance improvement compared to standard needles during ultrasound-guided vascular access with a vascular access model in the short axis.
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Postintubation chest X-rays (CXR) are standard practice in emergency department (ED) intubations. In the operating room, it is not usually a standard practice to confirm endotracheal tube placement with a CXR. ⋯ ED intubations were judged to have "satisfactory" placement by CXR in 81% of patients. CXR is able to identify a small subset of patients that likely need immediate intervention based on their CXR. Until further studies refute the utility of postintubation CXR in ED intubations, they should remain a part of routine practice.
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Analgesic use, particularly opioids in the emergency situation in patients with acute abdominal pain, generally has been avoided in the past; however, newer evidence has shown that the practice should be encouraged. In spite of this, many physicians still withhold analgesics in this clinical situation. ⋯ The study has shown that the dogma that analgesics are harmful in patients with acute abdominal pain is still firmly entrenched in the practice of the surveyed Nigerian doctors. This belief is not significantly affected by specialty or post-qualification experience.