Emergency medicine journal : EMJ
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A short cut review was conducted to assess if the use of rocuronium in the ED was associated with a decrease in the provision of postintubation sedation. Four papers were identified that presented the best evidence to answer the question. ⋯ All the identified studies were retrospective and there was a plethora of outcome measures used. When compared with suxamethonium, rocuronium was associated with a delayed initiation and reduced dose of postintubation sedation.
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Randomized Controlled Trial
Effect of wrist dorsiflexion on ultrasound-guided radial artery catheterisation using dynamic needle tip positioning technique in adult patients: a randomised controlled clinical trial.
It is generally recommended to keep the wrist joint mildly dorsiflexed during radial artery catheterisation. However, wrist dorsiflexion might decrease the success rate of radial artery catheterisation with dynamic needle tip positioning technique. Therefore, we assessed the success rates of two groups with or without wrist dorsiflexion by 5 cm wrist elevation in adult patients. ⋯ Wrist dorsiflexion may not be a necessity for ultrasound-guided radial artery catheterisation using dynamic needle tip positioning technique in adult patients.
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Observational Study
Can emergency department clinicians diagnose gamma-hydroxybutyrate (GHB) intoxication based on clinical observations alone?
Gamma-hydroxybutyrate (GHB) is a drug of abuse with central depressing effects, which may cause coma with a GCS score as low as 3. A rapid diagnosis 'GHB intoxication' may prevent unnecessary diagnostic work-up and may lead to guided, less invasive, treatment. The aim of this study was to evaluate if ED physicians' clinical evaluation were sufficient for diagnosis in patients with suspected GHB-intoxication. ⋯ Physicians underestimate the presence of GHB intoxication and can fail to diagnose GHB intoxication based on clinical observations alone. In the future, a rapid reliable initial analytical GHB test in addition to clinical judgement could be valuable to reduce false negative diagnosis.
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Case Reports
BET 1: Everything in graduation: arterial/end-tidal CO2 gradient and the diagnosis of pulmonary embolism.
A short cut review was carried out to establish the diagnostic characteristics of alveolar dead space fraction (AVDSf) in the diagnosis of pulmonary embolism (PE). This is calculated from the arterial and end-tidal CO2 Three papers were selected to answer the clinical question. ⋯ It is concluded that there is good evidence to support the use of AVDSf within a clinical prediction model to exclude a PE in patients when there is a low pretest probability. However, the specificity is not sufficient to support it as a 'rule in' test.