International journal of emergency medicine
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Intraosseous (IO) access is an alternative to conventional intravenous access. ⋯ The use of the EZ-IO provides a fast, easy and reliable alternative mode of venous access, especially in the resuscitation of patients with no venous vascular access in the emergency department. Flow rates may be improved by the use of pressure bags.
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International research has demonstrated disparities in the Emergency Department care of patients of certain racial or ethnic backgrounds. The management of minor head injuries requires a careful clinical assessment to determine the requirement of a CT scan of the head. The aim of this study was to determine if there was any disparity, based on race, in the management of minor head injury. ⋯ This study concluded that there was no statistically significant disparity based upon race in the management of minor head injuries with regard to decision to perform a CT head scan. There is some evidence that indigenous patients waited longer to be seen. A multi-centre prospective study is necessary to confirm these findings.
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It has been shown that residents' ability to see more patients and patients of higher acuity improves with level of training. ⋯ Instead of tiring, residents maintain or improve productivity over consecutive shifts.
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Lumbar punctures (LP) are regularly and effortlessly used in the emergency medical departments (EMD). LP use and efficiency have not been fully explored in the published literature. ⋯ Our results are in accordance with the few published surveys on this topic. LP efficiency is modest but must be considered in light of the seriousness of suspected diagnoses. However, the search for differential diagnoses should not be neglected.
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There are no general policies or protocols for procedural sedation in the emergency department and no literature on present practice in South Africa. ⋯ The private sector is generally better serviced for PS than the public sector. Most ED clinicians use morphine and midazolam for PS. However, there is widespread awareness of propofol as an alternative and probably superior PS drug. Recommendations for improving PS include development of general protocols for PS, training of doctors at all levels and optimization of ED facilities and staffing.