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Mixed Adult (mixed + adult)

Distribution by Scientific Domains
Medical Sciences75%

Selected Abstracts

The Implementation of Intranasal Fentanyl for Children in a Mixed Adult and Pediatric Emergency Department Reduces Time to Analgesic Administration

ACADEMIC EMERGENCY MEDICINE, Issue 2 2010
Anna Holdgate MBBS, FACEM
ACADEMIC EMERGENCY MEDICINE 2010; 17:1,4 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to determine whether the introduction of intranasal (IN) fentanyl for children with acute pain would reduce the time to analgesic administration in a mixed adult and pediatric emergency department (ED). Methods:, A protocol for IN fentanyl (1.5 ,g/kg) for children age 1,15 years presenting with acute pain was introduced to the department. All children who received intravenous (IV) morphine in the 7 months prior to the introduction of the protocol and either IV morphine or IN fentanyl in the 7 months after the introduction of the protocol were identified from drug registers. Time to analgesic administration, time to see a doctor, and the ages of patients were compared between the periods before and after the introduction of IN fentanyl. Results:, Following implementation, 81 patients received IN fentanyl and 37 received IV morphine, compared to 63 patients receiving morphine in the previous 7 months. The median time to analgesic administration for IN fentanyl was significantly shorter than for morphine (32 minutes vs. 63 minutes, p = 0.001). Children receiving fentanyl were significantly younger than those receiving morphine (median = 8.5 years vs. 12 years, p < 0.001). Conclusions:, This study demonstrates that children treated with IN fentanyl received analgesic medication faster than those treated with IV morphine in a mixed ED. Younger children were more likely to receive opioid analgesia following the introduction of fentanyl. [source]

Fast track: Has it changed patient care in the emergency department?

EMERGENCY MEDICINE AUSTRALASIA, Issue 1 2008
Paul Kwa
Abstract Objective: To determine whether the introduction of a designated fast-track area altered the time to care and patient flow in an Australian mixed adult and paediatric ED. Methods: Retrospective cohort study of all patients presenting to the ED between 08.00 and 22.00 hours, during a 6 month period before and after the opening of a fast-track area. Data were stratified according to Australasian Triage Scale (ATS) category, and comparisons were made for performance indicators, waiting time, length of stay and did-not-waits. Results: During its operational hours, fast track managed 14.9% of all patients presenting to the ED. There was a significant increase in the proportion of all ATS 4 patients seen within their target times (77.8% to 79.9%, P < 0.001). There was a trend towards improved performance in ATS categories 2, 3 and 5. Median patient waiting times were significantly decreased in ATS 4 (24 to 22 min, P < 0.001) and ATS 5 (27 to 25 min, P < 0.05), but increased in ATS 2 (3 to 4 min, P < 0.05). No deterioration in performance or waiting time for ATS 1 was shown. There was a decreasing trend in the proportion of patients who did not wait to be assessed by a doctor in ATS categories 4 and 5. These improvements occurred despite a 12% increase in patient attendances and no change in medical staffing levels. Conclusions: Fast track in an Australian mixed ED can help meet the demand of increasing patient attendances, allowing lower-acuity patients to be seen quickly without a negative impact on high-acuity patients. [source]

The Implementation of Intranasal Fentanyl for Children in a Mixed Adult and Pediatric Emergency Department Reduces Time to Analgesic Administration

ACADEMIC EMERGENCY MEDICINE, Issue 2 2010
Anna Holdgate MBBS, FACEM
ACADEMIC EMERGENCY MEDICINE 2010; 17:1,4 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to determine whether the introduction of intranasal (IN) fentanyl for children with acute pain would reduce the time to analgesic administration in a mixed adult and pediatric emergency department (ED). Methods:, A protocol for IN fentanyl (1.5 ,g/kg) for children age 1,15 years presenting with acute pain was introduced to the department. All children who received intravenous (IV) morphine in the 7 months prior to the introduction of the protocol and either IV morphine or IN fentanyl in the 7 months after the introduction of the protocol were identified from drug registers. Time to analgesic administration, time to see a doctor, and the ages of patients were compared between the periods before and after the introduction of IN fentanyl. Results:, Following implementation, 81 patients received IN fentanyl and 37 received IV morphine, compared to 63 patients receiving morphine in the previous 7 months. The median time to analgesic administration for IN fentanyl was significantly shorter than for morphine (32 minutes vs. 63 minutes, p = 0.001). Children receiving fentanyl were significantly younger than those receiving morphine (median = 8.5 years vs. 12 years, p < 0.001). Conclusions:, This study demonstrates that children treated with IN fentanyl received analgesic medication faster than those treated with IV morphine in a mixed ED. Younger children were more likely to receive opioid analgesia following the introduction of fentanyl. [source]

A systematic review of the features that indicate intentional scalds in children

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2009
Richard Reading
A systematic review of the features that indicate intentional scalds in children . MaguireS., MoynihanS., MannM., PotokarT. & KempA. M. ( 2008 ) Burns , 34 , 1072 , 1081 . DOI: 10.1016/j.burns.2008.02.011 . Background Most intentional burns are scalds, and distinguishing these from unintentional causes is challenging. Aim To conduct a systematic review to identify distinguishing features of intentional and unintentional scalds. Methods We performed an all language literature search of 12 databases 1950,2006. Studies were reviewed by two paediatric/burns specialists, using standardized methodology. Included: Primary studies of validated intentional or accidental scalds in children 0,18 years old and ranked by confirmation of intentional or unintentional origin. Excluded: Neglectful scalds; management or complications; studies of mixed burn type or mixed adult and child data. Results A total of 258 studies were reviewed, and 26 included. Five comparative studies ranked highly for confirmation of intentional/unintentional cause of injury. The distinguishing characteristics were defined based on best evidence. Intentional scalds were commonly immersion injuries, caused by hot tap water, affecting the extremities, buttocks or perineum or both. The scalds were symmetrical with clear upper margins, and associated with old fractures and unrelated injuries. Unintentional scalds were more commonly due to spill injuries of other hot liquids, affecting the upper body with irregular margins and depth. Conclusions We propose an evidence-based triage tool to aid in distinguishing intentional from unintentional scalds, requiring prospective validation. [source]