No abstract

The objective of the report was to study the efficacy and safety of ketamine and midazolam combination in the procedural sedation of incision and drainage of abscesses in the adult emergency department (ED) patients. This prospective observational study enrolled patients aged 16-60 years (American Society of Anesthesiologists class I) requiring abscess drainage in an adult ED. Patients received 2 mg/kg of ketamine infusion over 5 min and midazolam 2-5 mg titrated to deep sedation according to Ramsay sedation scale. Primary outcome was patient satisfaction using pain score after procedure. Secondary outcomes included adverse effects, hemodynamics alterations and recovery time. Descriptive statistics were calculated using SPSS software. Fifteen patients were recruited. One patient was excluded because of difficulty with pain score interpretation. Seventy-nine percent were male patients. The mean age was 29. The mean size of abscess was 3.4 cm. The mean dose of midazolam was 3.2 mg. Eighty-six percent did not experience any pain for the procedure. Only two patients (14%) reported mild pain during the procedure. There were no significant adverse events or complications. Three patients had giddiness, two had vomiting and only one reported an unpleasant dream. The median systolic blood pressure and heart rate elevation were 30+/-5.1 mmHg and 12.5+/-3.2/min, respectively. The median time for blood pressure and pulse rate to return to baseline was 20+/-2.7 min. The use of ketamine and midazolam sedation is both well tolerated and effective for adults in the ED undergoing incision and drainage of abscesses. This study is limited by the small sample size.

We aim to define the characteristics of patients with hand injuries in the emergency department (ED), their management and operative findings. Decision on admission was also analyzed between the ED and the hand and reconstructive microsurgical team. We reviewed 504 patients seen at the ED over a 3-month period with isolated hand injuries and found more males (88%) who were between 20 and 30 years of age (51%). Most had industrial injuries (43%) from lacerations or crush. Left hand injuries were more common. About 62% of the patients were discharged after treatment at the ED while 38% were admitted. A high level of concurrence in the decisions made by the ED and hand and reconstructive microsurgery signifies good quality assessment performed by the ED. The operative findings of fractures, tendon, nerve and vessel injuries for those who were admitted to the wards are higher than those admitted to 'day surgery'.

The most common initial rhythm in a sudden cardiac arrest is ventricular fi brillation or pulseless ventricular tachycardia. This is potentially treatable with defi brillation, especially if provided early. However, any delay in defi brillation will result in a decline in survival. Defi brillation requires coordination with the cardiopulmonary resuscitation component for effective resuscitation. These two components, which form the key links in the chain of survival, have to be brought to the cardiac victim in a timely fashion. An effective chain of survival is needed in both the institution and community settings.