Emergency medicine journal : EMJ
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Clinical Trial
The Lancaster experience of 2.0 to 2.5 mg/kg intramuscular ketamine for paediatric sedation: 501 cases and analysis.
To report the experience of using intramuscular ketamine 2.0 or 2.5 mg/kg for minor painful procedures in children in a medium sized district general hospital accident and emergency department. To demonstrate the safety and acceptability of ketamine and determine if the incidence of adverse effects is related to dose or other variables. ⋯ 2.0 - 2.5 mg/kg intramuscular ketamine sedation is a safe and acceptable technique when used within a defined protocol. Lower dose ketamine (2 mg/kg) warrants further study in view of potentially less airway complications and quicker discharge times than previously reported.
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To further evaluate the safety profile and efficacy of intramuscular ketamine for procedural sedation during paediatric minor procedures in the emergency department and to ascertain parental satisfaction with the treatment of their children. ⋯ High levels of satisfaction among parents and staff together with the avoidance of hospital admission and improved resource management should be a sufficient incentive for hospital trusts to consider the establishment of this type of service.
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Transverse sacral fractures associated with cauda equina syndrome are uncommon lesions and often missed at the time of presentation. This case report highlights the benign presentation and the unpleasant outcome of such an injury.
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To identify those attributes experts regard as desirable qualities in the ambulance technician, paramedic, and clinical supervisor. ⋯ There was significant agreement among the experts as to the desirable attributes of ambulance staff, many of which do not feature in existing ambulance training curriculums. The findings of this study may therefore be of value in informing future curriculum development and in providing guidance for the selection of staff for each of the occupational groups.
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The relief of pain is an essential component of prehospital care and, when required is usually administered on completion of the primary survey. For simple analgesia morphine sulphate titrated to the clinical response and preceded by an antiemetic is usually effective, for example, in the relief of pain in chest trauma or myocardial infarction. For patients with multiple injuries and for those patients requiring manipulation and splintage of fractures and for entrapments and difficult extrications ketamine is a safe and effective option, which avoids the potential decrease in blood pressure and respiratory depression that is associated with opioid analgesia. This paper reports the personal experience in the prehospital administration of ketamine by a non-anaesthetist working as an immediate care practitioner as part of a British Association for Immediate Care (BASICS) Scheme.