Flexible endoscopy was used to assess the intragastric residue after either ipecacuanha-induced emesis or gastric lavage in 30 self-poisoned patients. Of the 13 patients treated by induced-emesis, five (38.5%) had residual solid in the stomach; 17 patients were treated by gastric washout, and 15 (88.2%) of these had residual intragastric solid. The study provides direct evidence that the gastric decontaminating procedures employed, and especially gastric lavage, do not remove stomach contents completely.
Objective-To evaluate accident and emergency (A&E) department led practice of ketamine sedation for painful, short procedures in the paediatric population and to ascertain parental response. Methods-Analysis of retrospective data for all children who received ketamine sedation over a 20 month period in a district general hospital. A data extraction form was used to record age, sex, dose, indication, side eVects, and outcome. The parents were contacted by telephone afterwards and asked standardised questions about the child's treatment, their progress after discharge, and overall satisfaction with the treatment. Results-Intramuscular ketamine was administered to 100 children under 12 years of age during the study period. The drug caused no adverse events pre-operatively or intraoperatively. The main early postoperative complication was vomiting (14%). Ninety three per cent of patients were discharged the same day. No reattendance or treatment attributable to ketamine related side eVects were necessary. Over the 24 hours after discharge, vomiting occurred in 12% and ataxia in 15% of patients. Ninety nine per cent of parents were either very satisfied or satisfied with ketamine sedation and were willing for their child to receive it again, if required. Conclusion-This study, while confirming the known safety of ketamine sedation, established its suitability for "independent" use within A&E departments by suitably qualified staV. (J Accid Emerg Med 2000;17:25-28)
SummaryA prospective, randomized, single-blind study was carried out to determine whether gastric content is forced into the small bowel when gastric-emptying procedures are employed in self-poisoned patients. They were asked to swallow barium-impregnated polythene pellets, immediately prior to either gastric lavage or ipecacuanha-induced emesis. A second group of patients, who did not require treatment, were used as controls. Sixty patients were recruited to the study. The data show a significant difference in the number of residual pellets in the small bowel of the treated group (n=40), when compared with the control group (P< 0.0001). There was no statistical difference in the number of pellets in the small bowel when the treated groups were compared with each other. In addition, the inefficiency of gastric-emptying procedures is highlighted; 58.5% of the total number of pellets ingested were retained in the gastrointestinal tract of the ipecacuanha-treated group, while 51.8% oftotal pellets ingested were retained in the gastric lavage-treated group. IntroductionThe value and effectiveness of gastric decontaminating procedures have been doubted by several authorities over the years':". There is controversy in the medical literature concerning the efficiency of gastric emptying procedures, and which, if any, is more usefulv".Significant residual quantities of the markers sucralfate and cyanocobalamin have been demonstrated in ipecacuanha-treated patientst-", Large residues of food and tablets have been demonstrated endoscopically after both techniques of emptying", Curtis et al. l o have demonstrated superiority using activated charcoal when compared with gastric lavage and ipecacuanha-induced emesis.It is theoretically possible that the use of gastricemptying procedures may force gastric content into the small intestine. Therefore, we decided to study the fate of radio-opaque polythene pellets in self-poisoned patients, in order to assess the effect of gastricemptying procedures on gastric content.
Objectives: To further evaluate the safety profile and efficacy of intramuscular ketamine for procedural sedation during paediatric minor procedures in the emergency department and to ascertain parental satisfaction with the treatment of their children. Methods: A prospective audit of ketamine use in a UK district general hospital involving 89 children requiring minor procedures. Children received topical anaesthesia followed by an intramuscular injection of ketamine 4 mg/kg and intramuscular atropine 0.02 mg/kg. The procedure was assessed by way of a physician completed form and by evaluation of questionnaires given to parents to gauge levels of satisfaction. Results: No child required admission to hospital and there were no serious complications. A high level of satisfaction was expressed by all the parents/guardians of the children treated. Conclusions: High levels of satisfaction among parents and staff together with the avoidance of hospital admission and improved resource management should be a sufficient incentive for hospital trusts to consider the establishment of this type of service.
25 patients were assessed following repair of an acutely ruptured ulnar collateral ligament of the thumb metacarpo-phalangeal joint. The patients were divided into two groups, repaired by either a horizontal mattress suture using 4/0 polybutylate (nine patients), or a pre-fashioned steel wire (16 patients). Assessment included a physical examination and functional testing at a mean of 12.9 months (range 4-36 months) after the operation. Both techniques were equally effective, and the use of the more expensive steel wire, while technically satisfying and easy to perform, offers no clinical advantage over simple suture. This pre-fashioned steel wire is, however, recommended in those cases with an avulsion fracture or where distal avulsion of the ligament is associated, since the technique allows easy secure reduction.
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