Emergency medicine journal : EMJ
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Randomized Controlled Trial Comparative Study Clinical Trial
Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation.
This study compared intranasal midazolam (INM) with a combination of intravenous ketamine and intravenous midazolam (IVKM) for sedation of children requiring minor procedures in the emergency department. ⋯ Intravenous ketamine plus midazolam used in an appropriate setting by experienced personnel provides an excellent means of achieving sedation suitable for most non-painful minor procedures for children in the emergency department. This combination is superior to INM in terms of speed of onset and consistency of effect. INM delivered via aerosol spray has a more variable effect but may still be adequate for the completion of many of these procedures.
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For pre-hospital spinal immobilisation the spinal board is the established gold standard. There are concerns that its subsequent use in hospital may adversely affect patient outcome. This review examines the effect of prolonged patient immobilisation on the spinal board. ⋯ The spinal board should be removed in all patients soon after arrival in accident and emergency departments, ideally after the primary survey and resuscitation phases.
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A case is reported of the Lazarus phenomenon (the return of spontaneous circulation after cardiopulmonary resuscitation had been abandoned) in a patient following recreational drug use. The implications for management of cardiac arrest in the emergency department are discussed.