Saturday, February 26, 2011

Analgesia use for abdominal pain in ED : EBM

Very interesting articles to share from evidence based medicine...opioid may alter physical finding but not increase management errors. With advancement of the technology in ED (ultrasound, Ct scan) there is in favour of analgesia as mention by commentor. If needed pain killer just go ahead....
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Wednesday, February 9, 2011

Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation: 2011 Updated

Guidelines for use of ketamine in emergency department (ED) procedural sedation have been updated for the first time since 2004; the use of ketamine has been expanded to include adults and babies between 3 and 12 months of age, according to a new report.

Study Highlights.

Changes since the 2004 guidelines include the following:
  • The updated guidelines now support expansion of ketamine use to children aged 3 to 12 months, which is younger than previously recommended, as well as to adults.
  • Minor oropharyngeal procedures and head trauma are no longer contraindications to ketamine use.
  • Emergency medicine physicians should administer ketamine intravenously instead of intramuscularly whenever feasible because recovery is faster and there is less emesis.
  • Routine use of prophylactic anticholinergic medications is no longer recommended.
  • Routine use of prophylactic benzodiazepines is not recommended for children but may be helpful in adults (eg, midazolam 0.03 mg/kg intravenously; number needed to benefit = 6).
  • Prophylactic use of ondansetron may slightly reduce vomiting (number needed to benefit ≥ 9)
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