Emergency medicine journal : EMJ
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Multicenter Study Comparative Study Clinical Trial
Endotracheal intubation using a GlideScope video laryngoscope by emergency physicians: a multicentre analysis of 345 attempts in adult patients.
To investigate the use and success rates of the GlideScope (GVL) by emergency physicians (EPs) during the initial two years after its introduction. ⋯ The GVL was not used frequently by EPs during the initial two years after its introduction. Although the GVL provides a better glottic view, the overall success rates were similar to a CL. The GVL may be useful in patients with difficult airway.
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Comparative Study
The end of the line? The Visual Analogue Scale and Verbal Numerical Rating Scale as pain assessment tools in the emergency department.
To compare the Visual Analogue Scale (VAS) and the Verbal Numerical Rating Scale (VNRS), in the assessment of acute pain in the emergency department (ED). Furthermore, to determine the influence of demographics on this agreement and practical limitations of the scales. ⋯ VAS and VNRS are not interchangeable in assessing an individual patient's pain over time in the ED setting. VNRS has practical advantages over VAS in this setting.
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Many patients present late after a transient ischaemic attack (TIA). This delays intervention and may partly depend on where patients first present--emergency department (ED) or general practitioner (GP). Studying this behaviour could improve stroke prevention through better targeting of public education and allocation of resources. ⋯ Most patients presenting to an ED go urgently, whereas most going to a GP delay, particularly at weekends. Most Canadian patients, particularly those at high risk, go to an ED whereas most UK patients go to a GP. One way to reduce delay, particularly in the UK, would be to direct all patients with TIA to go to an ED rather than to their GP.
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Early goal-directed therapy (EGDT) has been shown to improve outcome in patients presenting to the emergency department (ED). Uptake of EGDT in EDs in the UK has been slow. ⋯ Full delivery of EGDT by ED staff would require significant consultant support, improved training of juniors and flexibility in the 4 h target. This study suggests that it may be practical for EGDT to be initiated in the ED and that early referral to critical care will remain essential if patients are to receive the full benefit of this intervention.
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Nefopam hydrochloride (Acupan) is a potent non-opioid analgesic widely used for the relief of moderate to severe postoperative pain. The drug is generally well tolerated, but it has a broad spectrum of side effects including tachycardia, sweating, nausea, seizures and hallucinations. ⋯ The case is presented of a previously healthy 19-year-old man who presented to the emergency department in cardiac arrest following intentional nefopam overdose. It is only the fourth reported case of fatal nefopam overdose in the literature.