Emergency medicine journal : EMJ
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Review Meta Analysis Comparative Study
Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis.
Establishing intravenous access is often vital in an acute hospital setting but can be difficult. Ultrasound-guided cannulation increases success rates in prospective studies. However, these studies have often lacked a comparative group. This systematic review and meta-analysis aimed to determine the clinical effectiveness of Ultrasound-guided peripheral intravenous cannulation compared with the standard technique in patients known to have difficult access. ⋯ Ultrasound guidance increases the likelihood of successful peripheral cannulation in difficult access patients. We recommend its use in patients who have difficult venous access, and have failed venous cannulation by standard methods. Further randomised controlled trials (RCTs) with larger sample sizes would be of benefit to investigate if Ultrasound has any additional advantages in terms of reducing the procedure time and the number of skin punctures required for successful venous cannulation.
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A short-cut review was carried out to determine whether metoclopramide or prochlorperazine was better at relieving headache in patients attending the emergency department with acute migraine. Eighty-one papers were found using the reported searches, of which three 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 those best papers are shown in table 1. It is concluded that in adult patients presenting to the emergency department with acute migraine, prochlorperazine 10 mg is better than metoclopramide 10 mg at relieving headache.
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Comparative Study
The usefulness of rapid point-of-care creatinine testing for the prevention of contrast-induced nephropathy in the emergency department.
Renal dysfunction is the most important factor to consider when predicting a patient's risk of developing contrast-induced nephropathy (CIN). Measurement of creatinine (Cr) via rapid point-of-care blood urea nitrogen/creatinine testing (POCT-BUN/Cr) to determine CIN risk could potentially reduce the time required to achieve an accurate diagnosis and to initiate and complete treatment in the emergency department (ED). The aim of our study was to compare the results of POCT-BUN/Cr and reference laboratory tests for BUN and serum Cr. ⋯ This study suggests that POCT-BUN/Cr results correlate well with those of serum reference tests in terms of BUN and Cr levels and, in turn, predicting CIN. POCT-BUN/Cr is easily performed with a rapid turnaround time, suggesting its use in the ED may have substantial clinical benefit.
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Ascertain recipients' level of satisfaction with humanitarian response efforts. ⋯ Access-limiting issues were rarely captured during routine monitoring and evaluation efforts and seem to be a significant predictor in dissatisfaction with relief efforts, at least in the case of Pakistan, another argument in favor of independent, population-based surveys of this kind. There is also need to better identify and serve those not residing in camps. Direct surveys of the affected population can be used operationally to assess ongoing needs, more appropriately redirect humanitarian resources, and ultimately, judge the overall quality of a humanitarian response.
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Due to lack of sufficient data it is difficult to understand fully the pattern of abdominal injury after an earthquake. This study aimed to evaluate the pattern of abdominal injury by analysing the data of trauma patients with abdominal injury incurred during the 2008 Wenchuan earthquake. ⋯ Abdominal injuries are relatively uncommon in earthquake disasters and often present with associated injuries. A timely and complete diagnosis of both abdominal as well as associated injuries is of primary importance in the treatment of patients with abdominal injuries. Knowledge of different types of abdominal injury, and their relative proportions, prevalence of associated injuries, risk factors and final clinical outcomes observed in this study may be of valuable reference in dealing with major earthquake events in the future.