Emergency medicine journal : EMJ
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Comparative Study
Prehospital trauma management: a national study of paramedic activities.
The benefits of prehospital trauma management remain controversial. This study aimed to compare the processes of care and outcomes of trauma patients treated by paramedics, who are trained in advanced prehospital trauma care, with those treated by ambulance technicians. ⋯ This large scale national study shows that paramedics show good triage skills and clinical judgement when managing trauma patients. However, the value of the individual interventions they perform could not be ascertained. Further controlled trials are necessary to determine the true benefits of advanced prehospital trauma life support.
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Randomized Controlled Trial Comparative Study Clinical Trial
Percutaneous regional compared with local anaesthesia for facial lacerations: a randomised controlled trial.
Facial lacerations are usually repaired after local infiltration of an anaesthetic agent. Regional nerve blocks of the face offer several theoretical advantages over local infiltration. This study compared the pain of injection and anaesthetic efficacy of percutaneous regional and local anaesthesia for facial lacerations. ⋯ Local infiltration of anaesthetics for facial lacerations is less painful and results in more effective anaesthesia than percutaneous regional infiltration.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised controlled trial of patient controlled analgesia compared with nurse delivered analgesia in an emergency department.
To compare effectiveness, safety, and patient satisfaction of patient controlled analgesia (PCA) with titrated, intravenous opioid injections for the management of acute traumatic pain in the emergency department (ED). ⋯ PCA is at least as effective as titrated intravenous injections for relief of traumatic pain. It has considerable potential for use in the ED.
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Effective resuscitation includes the rapid identification and correction of an inadequate circulation. Shock is said to be present when systemic hypoperfusion results in severe dysfunction of the vital organs. The finding of normal haemodynamic parameters, for example blood pressure, does not exclude shock in itself. This paper reviews the pathophysiology, resuscitation, and continuing management of the patient presenting with shock to the emergency department.
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A short cut review was carried out to establish whether intubation is always required in patients presenting with a decreased conscious level after gamma-hydroxybutyrate ingestion. Altogether 95 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.