Quality improvement initiatives targeting emergency airway management may be successfully implemented in the emergency department and are associated with a reduction in adverse intubation-related events.
This article reviews the evidence for the analgesic efficacy of methoxyflurane in both prehospital and ED settings, as well as the adverse event profile associated with methoxyflurane use. Although there are no published controlled trials of methoxyflurane in subanaesthetic doses, available data indicate that it is an efficacious analgesic. There is inadequate evidence regarding its use as an agent for procedural pain. Despite the potential for renal impairment evident when it was used in anaesthetic doses, no significant adverse effects have been reported in the literature, neither in patients nor occupationally, when the dose used is limited to that currently recommended.
BackgroundSafety of emergency intubation may be improved by standardising equipment preparation; the efficacy of cognitive aids is unknown.MethodsThis randomised controlled trial compared no cognitive aid (control) with the use of a checklist or picture template for emergency airway equipment preparation in the Emergency Department of The Royal Children’s Hospital, Melbourne.ResultsSixty-three participants were recruited, 21 randomised to each group. Equal numbers of nursing, junior medical, and senior medical staff were included in each group. Compared to controls, the checklist or template group had significantly lower equipment omission rates (median 30 % IQR 20–40 % control, median 10 % IQR 5–10 % checklist, median 10 % IQR 5–20 % template; p < 0.05). The combined omission rate and sizing error rate was lower using a checklist or template (median 35 % IQR 30–45 % control, median 15 % IQR 10–20 % checklist, median 15 % IQR 10–30 % template; p < 0.05). The template group had less variation in equipment location compared to checklist or controls. There was no significant difference in preparation time in controls (mean 3 min 14 s sd 56 s) compared to checklist (mean 3 min 46 s sd 1 min 15 s) or template (mean 3 min 6 s sd 49 s; p = 0.06).DiscussionTemplate use reduces variation in airway equipment location during preparation foremergency intubation, with an equivalent reduction in equipment omission rate to the use of a checklist. The use of a template for equipment preparation and a checklist for team, patient, and monitoring preparation may provide the best combination of both cognitive aids.ConclusionsThe use of a cognitive aid for emergency airway equipment preparation reduces errors of omission. Template utilisation reduces variation in equipment location.Trial registrationAustralian and New Zealand Trials Registry (ACTRN12615000541505).Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0201-z) contains supplementary material, which is available to authorized users.
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