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Procedural sedation emergency department

Anatole Vilhelm Wiik, Poonam Patel, Joanna Bovis, Adele Cowper, Philip Socrates Pastides, Alison Hulme, Stuart Evans, Charles Stewart
AIM: To determine if ketamine sedation is a safe and cost effective way of treating displaced paediatric radial and ulna fractures in the emergency department. METHODS: Following an agreed interdepartmental protocol, fractures of the radius and ulna (moderately to severely displaced) in children between the age of 2 and 16 years old, presenting within a specified 4 mo period, were manipulated in our paediatric emergency department. Verbal and written consent was obtained prior to procedural sedation to ensure parents were informed and satisfied to have ketamine...
March 18, 2018: World Journal of Orthopedics
Maya S Iyer, Raymond D Pitetti, Melissa Vitale
Introduction: Procedural sedation and analgesia (PSA) is used by non-anesthesiologists (NAs) outside of the operating room for several types of procedures. Adverse events during pediatric PSA that pose the most risk to patient safety involve airway compromise. Higher Mallampati scores may indirectly indicate children at risk for airway compromise. Medical governing bodies have proposed guidelines for PSA performed by NAs, but these recommendations rarely suggest using Mallampati scores in pre-PSA evaluations...
March 2018: Western Journal of Emergency Medicine
Javad Seyedhosseini, Jaleh Saiidian, Amirpejman Hashemi Taheri, Elnaz Vahidi
Background: Ultrasound (US) is an effective modality in the evaluation of shoulder dislocation and reduction. In most studies, high frequency US probes have been used. Objective: To determine the sensitivity and specificity of low frequency US in the diagnosis of shoulder dislocation and its proper reduction in the emergency department (ED). Methods: In a prospective observational study 84 patients, suspicious of shoulder dislocation, were enrolled in our study...
December 2017: Turkish Journal of Emergency Medicine
Reza Azizkhani, Azadeh Bahadori, Mohammadreza Shariati, Keyhan Golshani, Omid Ahmadi, Babak Masoumi
Background: The present study was designed to evaluate the effectiveness of magnesium sulfate (MgSO4 ) in procedural sedation and analgesia (PSA) when combined with ketamine in patients with fractures in emergency departments and required short and painful emergency procedures. Materials and Methods: In this study, 100 patients with fractures and dislocations who were presented to the emergency departments and required PSA for short and painful emergency procedures were randomly allocated to groups of ketamine plus MgSO4 or ketamine alone...
2018: Advanced Biomedical Research
Steven M Green, Mark G Roback, Baruch S Krauss
No abstract text is available yet for this article.
February 2, 2018: Annals of Emergency Medicine
Hamed Aminiahidashti, Sajad Shafiee, Seyed Mohammad Hosseininejad, Abulfazl Firouzian, Ayyub Barzegarnejad, Alieh Zamani Kiasari, Behzad Feizzadeh Kerigh, Farzad Bozorgi, Misagh Shafizad, Ahmad Geraeeli
OBJECTIVE: Many procedures performed in emergency department are stressful and painful, and creating proper and timely analgesia and early and effective assessment are the challenges in this department. This study has been conducted in order to compare the efficacy of propofol and fentanyl combination with propofol and ketamine combination for procedural sedation and analgesia (PSA) in trauma patients in the emergency department. METHOD: This is a randomized prospective double-blind clinical trial conducted in the emergency department of Imam Khomeini Hospital, a tertiary academic trauma center in northern Iran...
February 4, 2018: American Journal of Emergency Medicine
Corrie E Chumpitazi, Elizabeth A Camp, Divya R Bhamidipati, Almea M Montillo, A Chantal Caviness, Lesby Mayorquin, Faria A Pereira
BACKGROUND: There is no evidence of an association between fasting time and the incidence of adverse events during procedural sedation and analgesia. Pediatric and adult emergency medicine guidelines support avoiding delaying procedures based on fasting time. General pediatric guidelines outside emergent care settings continue to be vague and do not support a set fasting period for urgent and emergent procedures. OBJECTIVE: To describe shortened preprocedural fasting and vomiting event rates during the implementation of a shortened fasting protocol...
January 9, 2018: American Journal of Emergency Medicine
Meital Ben-Ari, Gilad Chayen, Ivan P Steiner, Dana Aronson Schinasi, Oren Feldman, Itai Shavit
In many countries, procedural sedation outside of the operating room is performed by pediatricians. We examined if in situ sedation simulation training (SST) of pediatricians improves the performance of tasks related to patient safety during sedation in the Emergency Department (ED). We performed a single-center, quasi-experimental, study evaluating the performance of sedation, before-and-after SST. Sixteen pediatricians were evaluated during sedation as part of their usual practice, using the previously validated Sedation-Performance-Score (SPS)...
January 25, 2018: Journal of Anesthesia
Zlatan Coralic, Hendry R Sawe, Juma A Mfinanga, Alfredo Cortez, Jennifer Koehl, Hannah Siroker, Teri A Reynolds
STUDY OBJECTIVE: We describe ketamine procedural sedations and associated adverse events in low-acuity and high-acuity patients in a resource-limited ED. METHODS: This was a prospective observational study of ketamine procedural sedations at the Emergency Medical Department at the Muhimbili National Hospital in Dar es Salaam, Tanzania. We observed consecutive procedural sedations and recorded patient demographics, medications, vital signs, pulse oximetry, capnography and a priori defined adverse events (using standard definitions in emergency medicine sedation guidelines)...
April 2018: Emergency Medicine Journal: EMJ
Luca Cabrini, Giovanni Landoni, Martina Baiardo Radaelli, Omar Saleh, Carmine D Votta, Evgeny Fominskiy, Alessandro Putzu, Cézar Daniel Snak de Souza, Massimo Antonelli, Rinaldo Bellomo, Paolo Pelosi, Alberto Zangrillo
BACKGROUND: We performed a systematic review of randomized controlled studies evaluating any drug, technique or device aimed at improving the success rate or safety of tracheal intubation in the critically ill. METHODS: We searched PubMed, BioMed Central, Embase and the Cochrane Central Register of Clinical Trials and references of retrieved articles. Finally, pertinent reviews were also scanned to detect further studies until May 2017. The following inclusion criteria were considered: tracheal intubation in adult critically ill patients; randomized controlled trial; study performed in Intensive Care Unit, Emergency Department or ordinary ward; and work published in the last 20 years...
January 20, 2018: Critical Care: the Official Journal of the Critical Care Forum
Woo Sung Kim, Ji Yeon Ku, Hanbyul Choi, Hyo Jeong Choi, Ho Jung Kim, Bora Lee
OBJECTIVE: Ketamine use in emergency departments (EDs) for procedural sedation and analgesia is becoming increasingly common. However, few studies have examined patient factors related to adverse events associated with ketamine. This study investigated factors for consideration when using ketamine to sedate pediatric ED patients. METHODS: The study included pediatric patients receiving ketamine for laceration repair in the ED. Before sedation, information was collected about upper respiratory tract infection symptoms, allergy history, and fasting time...
December 2017: Clinical and Experimental Emergency Medicine
Haley Baird, Rachel Rumbarger
Background: Ketamine in adults has been identified as a safe and effective alternative for multiple indications, each with specific evidence-based dosing ranges. Emergency department (ED) providers are tasked with appropriate ordering of ketamine. A multi-institutional retrospective analysis within EDs at a large health system from November 2013 to October 2015 reviewed ED adult ketamine prescribing patterns for procedural sedation (PS), rapid sequence intubation (RSI), and analgesia. Retrospective cohort results revealed 56% (84 of 150) of PS, 64% (16 of 25) of RSI, and 81...
July 2017: Hospital Pharmacy
Maybritt I Kuypers, Gaël J P Smits, Suzanne C Valkenet, Wendy A M H Thijssen, Frans B Plötz
BACKGROUND: Several efforts have been made to assure and to improve the quality of procedural sedation and analgesia (PSA) performed by emergency physicians (EPs) in The Netherlands. This study investigated the current PSA practice and competences of EPs in both adult and paediatric patients. In particular, if residency and current training, awareness of guidelines is sufficient for registered EPs to adequately perform PSA and if the availability of both adult and paediatric PSA in the ED is adequate...
December 15, 2017: International Journal of Emergency Medicine
Maybritt I Kuypers, Gaël J P Smits, Eva P Baerends, Erick Oskam, Eef P J Reijners, Lisette A A Mignot-Evers, Wendy A M H Thijssen, Frans B Plötz, Erik H M Korsten
OBJECTIVES: Paediatric patients receive less procedural sedation and analgesia (PSA) in the emergency department compared with adults, especially in countries where emergency medicine is at an early stage of development. The objectives of this study were to evaluate the adverse events and efficacy of paediatric PSA in a country with a recent establishment of emergency medicine and to describe which factors aided implementation. METHODS: This is a prospective, multicentre, observational study of paediatric patients undergoing PSA by the first trained emergency physicians (EPs) in The Netherlands...
December 13, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Clayton P Josephy, David R Vinson
OBJECTIVE: Sedation is commonly required for painful procedures in the emergency department (ED). Some facilities mandate two physicians be present for deep sedation cases. Evidence is lacking, however, that a two-physician approach improves safety outcomes. We report our experience on the feasibility of replacing a two-physician ED procedural sedation policy with a single-physician policy in a small, single-coverage community ED. METHODS: This is a retrospective, before/after, single-center observational study of prospectively collected data from January 2013 through December 2016...
November 3, 2017: American Journal of Emergency Medicine
Andrew F Miller, Michael C Monuteaux, Florence T Bourgeois, Eric W Fleegler
OBJECTIVES: Describe the trends in pediatric sedation use over time and determine variation in use of procedural sedation across children's hospital emergency departments (EDs). METHODS: We analyzed ED data from 35 hospitals within the Pediatric Health Information System for patients <19 years old who received sedation medications and were discharged from 2009 to 2014. Patients with chronic comorbidities or undergoing intubation were excluded. We determined frequency and trends in use of sedation and compared these between EDs...
January 2018: Hospital Pediatrics
Andrew Greer, Greg Treston
OBJECTIVES: To describe the proportion of patients reporting procedural memory following procedural sedation and analgesia (PSA) with ketamine and propofol (KP) administered premixed together (ketofol) or individually (sequential KP) in ED attendees. Identify any clinical or demographic variables associated with procedural memory. METHODS: This was a convenience sample of 563 patients who received KP PSA as per the departmental protocol. A standardised script was used to assess for procedural memory...
December 6, 2017: Emergency Medicine Australasia: EMA
Shirley Mulvaney
BACKGROUND: Forearm fractures are the most common paediatric injury presenting to A+E.1,2 Literature supports safe and effective treatment of these injuries in A+E using a variety of sedation methods, including ketamine.3,4 The Paediatric Orthopaedic Trauma Snapshot (POTS) study showed that only 35% of A+Es nationally allow manipulation of these injuries in the department. METHODS: A retrospective analysis was undertaken of all patients presenting with fractures of the forearm between January 2012 to December 2016 who were treated with reduction and manipulation in the Alder Hey A+E department using Es-ketamine...
December 2017: Emergency Medicine Journal: EMJ
Leonie Rose Bovino, Christina Brainard, Kristen Beaumier, Victoria Concetti, Nicole Lefurge, Emily Mittelstadt, Tabea Wilson, Melissa L Langhan
No abstract text is available yet for this article.
November 20, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Jen Heng Pek, Gene Yong-Kwang Ong
INTRODUCTION: Resuscitation of critically ill children can be chaotic, and emergency airway management is often fraught with difficulties. This study aimed to characterize the Singaporean landscape of tracheal intubation in a pediatric emergency unit, placing emphasis on safety outcomes, procedural process of care, and provider training. METHODS: A retrospective review of all cases presented to the KK Women's and Children's Hospital from January 2009 to December 2013 with intubation carried out within the pediatric emergency unit was done...
November 21, 2017: Pediatric Emergency Care
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