Introduction to disaster nursing:
Any emergency physician will tell you exactly how satisfying it is to treat a patient with SVT. But not everything is great about the way we manage SVT in practice. More often than not we revert to using adenosine.
This is a great drug — rapid onset, short-acting, safe — and we all know how effective it can be. We all know that we could. We could try carotid sinus massage, accepting the small but finite risk of causing a stroke. Or we could try a Valsalva manoeuvre. Well, 5 years ago two emergency physicians described a modified Valsalva manoeuvre that might improve success rates in the EMJ.
And their most awesome work has just been published in the Lancet. Essentially, the patient would puff into a sphygmomanometer at a pressure of 40mmHg for 15 seconds, then lie back in the Trendelenberg position with legs elevated.
You can see a video of Andy in action doing the modified Valsalva manoeuvre below… http: Essentially, they aimed to test the null hypothesis that, when compared to a standard Valsalva manoeuvre, the Prehospital emergency research paper Valsalva manoeuvre will not improve cardioversion rates measured 1 minute after the procedure.
That means this was a superiority trial — they were trying to disprove that hypothesis and show that the modified Valsalva manoeuvre is better than the standard one for achieving cardioversion. Who did they include? This seems pretty reasonable. How did they randomise patients?
They randomised patients to receive either the modified or standard Valsalva manoeuvre in equal 1: The patients were randomised using sealed envelopes. Could you exclude them from the trial and use that envelope for the next patient? Could you just open the next envelope?
In this trial the answer is actually no.
This group asked the team to sign and date the seal of the envelope before they broke it. They must sign and date before they break the seal and they must include the patient because the seal has been dated. Randomisation was stratified by centre so that there would be roughly equal numbers of patients in each treatment group at each centre.
This removes the potential for confounding by having unequal numbers in the groups at different centres. If the centres had different success rates and there were uneven numbers, this could have been a problem.
What did they do? Consenting patients received either the standard or modified Valsalva after randomisation. An ECG was then recorded 1 minute afterwards. This was later interpreted by an independent cardiologist to determine whether cardioversion had occurred.
If the ECG was missing, an endpoint committee used all other available information to determine whether cardioversion had occurred. The primary outcome, which is the most important measure of success, was return to sinus rhythm after 1 minute.
There were also a number of secondary outcomes, such as the rate of use of adenosine. Ultimately patients were included in the trial.
What did they FIND? The results are pretty impressive. This is an absolute risk reduction of The findings are equally impressive for some of the secondary outcomes.
In terms of safety, there was no difference in the incidence of serious adverse events. So what does this MEAN? Clearly, the findings are pretty impressive. My only remaining question is whether you need to adopt the Trendellenberg position after the strain or whether being in the supine position all along would be just as effective.You should draw up the additional appropriate dead space of the delivery device you choose.
In this table the ml represents a typical dead space in a 1 ml syringe connected to a syringe driven atomizer. Medical simulation, or more broadly, healthcare simulation, is a branch of simulation related to education and training in medical fields of various industries.
Simulations can be held in the classroom, in situ, or in spaces built specifically for simulation practice. It can involve simulated human patients - artificial, human or a combination of the two, educational documents with detailed.
Intranasal Naloxone for acute opiate overdose: Reducing needle stick risk, improving time to medication delivery Table of Contents: Introduction to intranasal naloxone (click here). Emergency Medicine Journal accepts submissions of a wide range of article types, including original research, reviews and image challenges.
The Author Information section provides specific article requirements to help you turn your research into an article suitable for EMJ. End Tidal Carbon Dioxide Monitoring During CPR: A Predictor of Outcome.
by Jinhee Nguyen, RN MSN. Introduction In the emergency department (ED), critical management of the patient’s airway, ventilation and chest compression requires the utmost effort and sophisticated technology to maximize successful timberdesignmag.comimately $1 billion is spent on emergency department and in-hospital care .
Biography Dr Jamie Ranse is an Early Career Researcher currently working as a Research Fellow in Emergency Care.
This is a joint appointment between Griffith University and the .