Emergency medicine journal : EMJ
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A short systematic review of the literature was undertaken to assess whether tranexamic acid (TXA) administration in the ED for neck of femur fractures was associated with improved outcomes for patients undergoing surgery. MEDLINE, EMBASE, Cochrane and Google Scholar databases were searched. ⋯ The author, date, country, study population, study type, outcomes, key results and study weaknesses were tabulated. Our results suggest early TXA administration in the ED for extracapsular neck of femur fractures appears to be safe and may reduce the need for perioperative blood transfusions.
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Advanced cardiovascular life support (ACLS) for cardiac arrest is a cornerstone of emergency care and yet remains poorly studied in low- and middle-income countries. We characterised the clinical epidemiology and outcomes of cardiac arrest and ACLS in an ED in central Haiti, a lower middle-income country with a nascent emergency care system. ⋯ In this lower middle-income setting, cardiac arrest in the ED was associated with poor survival despite ACLS. Survival may be impacted by limited resources for prearrest monitoring as well as for ongoing critical care.
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Thoracostomies, and subsequent placements of chest tubes (CTs), are a standard procedure in several domains of medicine. In emergency medicine, thoracostomies are indicated to release a relevant hemothorax or pneumothorax, particularly a life-threatening tension pneumothorax. In many cases, an initial finger-assisted thoracostomy is followed by placement of a CT to ensure continuous decompression of blood and air. ⋯ Although certainly not advocated as standard, the use of endotracheal tubes as CTs may be a suitable alternative or back-up solution in settings where commercial CTs are not readily available. We assume that this technique will be particularly of interest in settings with a high risk for thoracic injuries and limited availability of commercial CTs, for example, in military conflicts. Given the virtual absence of scientific data, more research on risks, benefits and patient outcome is required.