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Treating toxicity The use of lipid emulsions to resuscitate patients with toxicity due to local anaesthetics, such as bupivacaine cardiac toxicity, has been proposed in clinical literature. In this article, the authors cite the successful emergency resuscitation of a 73-year-old man who had developed circulatory arrest after being given a subcutaneous injection of bupivacaine 0.5%. Initial treatment based on the advanced life support protocol had failed and so a therapy with lipid emulsion had been administered, and had succeeded. The authors, who provide a review of related literature, argue that bupivacaine administered as intravascular injection, and its interaction with amitriptyline and carbamazepine, can lead to cardiac depression, severe arrhythmias, hypotension, and cardiac arrest. They conclude that intravenous lipid emulsion is the best therapy to treat bupivacaine systemic toxicity when traditional life support treatment has failed. Monti M, Monti A, Borgognoni F et al (2014) Treatment with lipid therapy to resuscitate a patient suffering from toxicity due to local anesthetics. Emergency Care Journal. 10, 1820, 41-44.

Cardiac arrest

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In this head-to-head debate, the authors provide opposing arguments about whether patients with cardiac arrest should be taken to hospital.

People with asthma may receive patient passports

EMERGENCY NURSE

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Journal scan

Research indicates that ambulance crews are best placed to deliver immediate cardiopulmonary resuscitation

One author is in favour on the grounds that out-of-hospital cardiac arrest is a leading cause of premature death and that rules for deciding when to stop resuscitation are fallible. The other author says that ambulance crews are best placed to deliver immediate cardiopulmonary resuscitation, which is usually the only treatment available for patients with cardiac arrest. Adams B, Benger J (2014) Should we take patients to hospital in cardiac arrest? British Medical Journal. doi: 10.1136/bmj.g5659

Pain management Pain management in emergency departments (EDs) is often inadequate because analgesia is delayed or insufficient. The authors of this article conducted a systematic literature review to identify interventions that improve pain management in EDs and identified 43 relevant studies. The interventions they identified include use of pain-scoring tools, implementation of guidelines and protocols, education of staff, and changes in nursing roles. The authors conclude that there is insufficient evidence to recommend the widespread adoption of any of the interventions, however, and call for a greater

understanding of the theories underlying interventions and the context in which they work. Sampson FC, Goodacre SW, O’Cathain A (2014) Interventions to improve the management of pain in emergency departments: systematic review and narrative synthesis. Emergency Medicine Journal. doi: 10.1136/emermed-2013-203079

Patient passport This article outlines the development, testing and evaluation of a patient passport designed specifically for people with severe asthma, who often prefer to self-manage rather than attend emergency services, and thereby put their lives at risk. The aims of the project were to ensure these patients attend EDs and improve their experiences of emergency care, and to help healthcare professionals make appropriate clinical decisions and deliver individualised emergency treatments. Newell K, Basi T, Hume S (2014) Development of a patient passport in asthma management. Nursing Standard. 29, 7, 37-42. Journal scan is compiled by Jennifer Sprinks November 2014 | Volume 22 | Number 7 17

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Cardiac arrest.

In this head-to-head debate, the authors provide opposing arguments about whether patients with cardiac arrest should be taken to hospital...
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