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Emergency Contraception: Current Methods, Usages and Issues: Current Women's Health Reviews, Vol. 2, No. 1. (February 2006), pp. 33-39.Man Misro, Sankar Chaki

Source: Current Women's Health Reviews, Vol. 2, No. 1. (February 2006), pp. 33-39.
Pervasive Computing in Emergency Situations: (2004)Vassilis Kostakos, Eamonn O'Neill

Source: (2004)
The experience of the nurse at triage influences the timing of CPAP intervention: Accident and Emergency Nursing, Vol. 11, No. 4. (October 2003), pp. 234-238.Increa sing attention in the last decade has shown that intervention of continuous positive airway pressure therapy (CPAP) in cardiogenic pulmonary oedema (CPO) markedly improves the outcome of patients presenting with acute respiratory failure. This study used a non-experiment al correlational design to research the relationship between the experience of the nurse, with the application of CPAP to patients presenting to a metropolitan emergency department with CPO and to establish what difference, if any, CPAP made to outcomes. A retrospective audit of records was used to extract data on all 54 patients that received CPAP over a 12-month period. The primary outcome measures were off CPAP within 2 h, transfer to intensive care unit (ICU) or cardiac care unit (CCU) and secondary outcome measures were length of hospital stay and death. There was a trend towards more experienced nurses attending patients who required immediate treatment or treatment within 10 min. These patients were more likely to be recognised at triage as requiring CPAP therapy. The early application of CPAP reduced hospital mortality, length of stay, and the need for intubation and ventilation. Attention needs to be given on how best to educate nurses so that more patients presenting with acute respiratory failure can benefit from nurses’ decision-makin g regarding the commencement of CPAP.J Macgeorge

Source: Accident and Emergency Nursing, Vol. 11, No. 4. (October 2003), pp. 234-238.
Situation awareness in emergency medical dispatch: International Journal of Human-Computer Studies, Vol. 61, No. 4. (October 2004), pp. 421-452.Situat ion awareness, and how systems can be designed to support it appropriately, have been a focus of study in dynamic, safety critical contexts such as aviation. The work reported here extends the study of situation awareness into the domain of emergency medical dispatch (EMD). The study was conducted in one of the largest ambulance services in the world. In this study, we encountered development and exploitation of situation awareness, particularly among the more senior EMD operators called allocators. In this paper we describe the notion of a `mental picture' as an outcome of situation awareness, how an awareness of the situation is developed and maintained, the cues allocators attend to, and the difficulties they face in doing so. One of the key characteristic s of ambulance control is that relatively routine behaviour is periodically interspersed with incidents that demand much higher levels of attention, but that the routine work must still be completed; operators exhibit contrasting levels of situation awareness for the different kinds of incidents. Our findings on situation awareness are related to those of others, particularly Endsley and Wickens. The observations and interviews enable us to propose high-level requirements for systems to support appropriate situation awareness, to enable EMD staff to complete their work effectively.An n Blandford, William

Source: International Journal of Human-Computer Studies, Vol. 61, No. 4. (October 2004), pp. 421-452.
Participatory design in emergency medical service: designing for future practice: (2006), pp. 161-170.Margit Kristensen, Morten Kyng, Leysia Palen

Source: (2006), pp. 161-170.
Magnesium sulfate for treating exacerbations of acute asthma in the emergency department.: Cochrane database of systematic reviews (Online), No. 2. (2000)BACKGROU ND: Treatment of acute asthma is based on rapid reversal of bronchospasm and arresting airway inflammation. There is some evidence that intravenous magnesium can provide additional bronchodilatio n when given in conjunction with standard bronchodilatin g agents and corticosteroid s. No systematic review of this literature has been completed on this topic. OBJECTIVES: To examine the effect of additional intravenous magnesium sulfate in patients with acute asthma managed in the emergency department. SEARCH STRATEGY: Randomised controlled trials were identified from the Cochrane Airways Review Group register. Bibliographies from included studies, known reviews and texts were searched. Primary authors and content experts were contacted. SELECTION CRITERIA: Randomised controlled trials or quasi-randomis ed trials were eligible for inclusion. Studies were included if patients presented with acute asthma and were treated with IV magnesium sulfate vs placebo. DATA COLLECTION AND ANALYSIS: Data were extracted and methodological quality was assessed independently by two reviewers. Missing data were obtained from authors. MAIN RESULTS: Seven trials were included (5 adult, 2 pediatric). A total of 665 patients were involved. Patients receiving magnesium sulfate demonstrated non-significan t improvements in peak expiratory flow rates when all studies were pooled (weighted mean difference: 29.4 L/min; 95% confidence interval: -3.4 to 62). In studies of people with severe acute asthma, peak expiratory flow rate improved by 52.3 L/min (95% confidence interval: 27 to 77.5). The forced expiratory volume in one second also improved by 9.8 % predicted (95% confidence interval: 3.8 to 15.8). Overall, admission to hospital was not reduced, odds ratio: 0.31 (95% confidence interval: 0.09 to 1.02). In the severe subgroup, admissions were reduced in those receiving magnesium sulfate (odds ratio: 0.10, 95% confidence interval: 0.04 to 0.27). No clinically important changes in vital signs or adverse side effects were reported. REVIEWER'S CONCLUSIONS: Current evidence does not support routine use of intravenous magnesium sulfate in all patients with acute asthma presenting to the emergency department. Magnesium sulfate appears to be safe and beneficial in patients who present with severe acute asthma.BH Rowe, JA Bretzlaff, C Bourdon, GW Bota, CA Camargo

Source: Cochrane database of systematic reviews (Online), No. 2. (2000)
Intravenous magnesium sulfate as an adjunct in the treatment of acute asthma.: Chest, Vol. 107, No. 6. (June 1995), pp. 1576-1581.STUD Y OBJECTIVE: This study was conducted to determine whether intravenous magnesium sulfate (MgSO4), when used as part of a standardized treatment protocol, can improve pulmonary function and decrease admission rate in patients presenting to the emergency department with exacerbations of asthma. DESIGN: In this randomized double-blind placebo-contro lled study, patients with acute asthma were treated with inhaled beta-agonists at regular intervals and intravenous (IV) steroids. At 30 min after entry, patients received either 2 g IV MgSO4 or IV placebo. Patients were monitored for up to 4 h with regular measurements of pulmonary function. Patients who were discharged from the emergency department were contacted at 1 day and 7 days for follow-up. SETTING: Emergency departments of a university-aff iliated, voluntary hospital and municipal hospital. PARTICIPANTS: Asthmatics aged 18 to 65 years during acute exacerbation with FEV1 less than 75% predicted both before and after a single albuterol treatment. INTERVENTIONS: Patients were given 2 g of MgSO4 or placebo as an adjunct to standardized emergency department procedure for acute asthma. MEASUREMENTS AND RESULTS: One hundred thirty-five patients were studied. Hospital admission rates were 35.3% for placebo-treate d group and 25.4% for the magnesium-trea ted group (p = 0.21). FEV1 measured at 120 min was 56% predicted for the placebo-treate d group and 55% predicted for the magnesium-trea ted group. (p = 0.92) For subgroup analysis, patients were divided into "severe" (baseline FEV1 < 25% predicted on presentation) or "moderate" (baseline FEV1, 25 to 75% predicted on presentation). For the severe group, admission rates were 78.6% (11/14) for the placebo-treate d group and 33.3% (7/21) for the magnesium-trea ted group (p = 0.009). For the moderate patients, admission rates were 22.4% (11/49) for the placebo-treate d group and 22.2% (10/25) for the magnesium-trea ted group (p = 0.98). There was no significant improvement in FEV1 in the moderate group for magnesium-trea ted patients. However, in the severe group, there was a significant improvement in FEV1 at 120 min and 240 min (p = 0.014 and 0.026, respectively). CONCLUSION: Intravenous MgSO4 decreased admission rate and improved FEV1 in patients with acute severe asthma but did not cause significant improvement in patients with moderate asthma.H Bloch, R Silverman, N Mancherje, S Grant, L Jagminas, SM Scharf

Source: Chest, Vol. 107, No. 6. (June 1995), pp. 1576-1581.
Intravenous magnesium therapy for moderate to severe pediatric asthma: results of a randomized, placebo-contro lled trial.: The Journal of pediatrics, Vol. 129, No. 6. (December 1996), pp. 809-814.OBJECT IVE: To evaluate the efficacy of intravenous magnesium (IVMg) therapy for moderate to severe asthma exacerbations in pediatric patients. DESIGN: Randomized, double-blind, placebo-contro lled, clinical trial. SETTING: Urban pediatric emergency department. PARTICIPANTS: Thirty-one patients aged 6 to 18 years who were being treated for an acute asthma exacerbation with peak expiratory flow rate (PEFR) less than 60% of the predicted value after receiving three beta 2-adrenergic nebulizer treatments. Interventions: Magnesium sulfate infusion, 25 mg/kg (maximum, 2 gm), or equivolume saline solution for 20 minutes. MEASUREMENTS AND RESULTS: Vital signs, O2 saturation by pulse oximetry, PEFR, forced vital capacity, forced expiratory volume at 1 second, and physical examination were serially recorded for 110 minutes, with serum magnesium concentrations measured before and after the 20-minute infusion. At 50 minutes the magnesium group had a significantly greater percentage of improvement from baseline in forced expiratory volume at 1 second (34% vs -1%; p = 0.05); this improvement was sustained and even greater at 110 minutes (75% vs 5%; p = 0.01). Results were similar for PEFR at 80 through 110 minutes (59% vs 20% at 110 minutes; p = 0.05) and for forced vital capacity (55% vs 8% at 80 minutes; p = 0.05). There were no significant intergroup differences in blood pressure at any point. Patients who received intravenous magnesium infusions were more likely to be discharged home from the emergency department than those who received placebo (4/15 vs 0/16; p = 0.03). CONCLUSIONS: Children treated with intravenous magnesium infusions for moderate to severe asthma had significantly greater improvement in short-term pulmonary function without any significant alteration in blood pressure, suggesting a role for this agent as an adjunct in the treatment of such patients.L Ciarallo, AH Sauer, MW Shannon

Source: The Journal of pediatrics, Vol. 129, No. 6. (December 1996), pp. 809-814.
Intravenous magnesium sulphate in the management of moderate to severe acute asthmatic children nonresponding to conventional therapy.: European journal of emergency medicine : official journal of the European Society for Emergency Medicine, Vol. 6, No. 3. (September 1999), pp. 201-205.Manage ment of severe acute asthma attacks in children sometimes bring difficulties to the physician. Some current treatment strategies have focused on intravenous magnesium sulphate administration in patients nonresponding to therapy with beta-2 agonists and corticosteroid s. The use and efficacy of this drug has been discussed in this randomized, double-blind, placebo-contro lled clinical trial consisting of 20 children with moderate to severe acute asthma exacerbation admitted to the emergency department in Dicle University Hospital, Turkey. Magnesium sulphate infusion therapy of 40 mg/kg doses (maximum 2 g) or an equivalent volume of normal saline solution were administered to randomly assigned 10 patients in each group to the selected patients who were being treated for an acute asthma exacerbation with a peak expiratory flow rate (PEFR) less than 60% of the predicted value after receiving three beta-2 adrenergic nebulizer treatments (salbutamol) given at an interval of 20 minutes each. Vital signs, PEFR and physical examinations were serially recorded at 15 minutes intervals for a total of 90 minutes after the initiation of magnesium sulphate therapy. At 30 minutes, compared with the placebo group, the magnesium sulphate receiving group had lower clinical asthma scores (4.0+/-0.5 vs. 5.5+/-0.5, p = 0.0002) and a significantly greater percentage of improvement from baseline in PEFR (43.0+/-6.3% vs. 14.6+/-3.7%, p = 0.0002). These significant changes persisted at 45, 60, 75 and 90 minutes. No significant side effects were observed. In conclusion, severe asthmatic cases may benefit from magnesium sulphate therapy when beta-2 agonists are inadequate in preventing deterioration. F Gürkan, K Haspolat, M Bo?nak, B Dikici, O Derman, A Ece

Source: European journal of emergency medicine : official journal of the European Society for Emergency Medicine, Vol. 6, No. 3. (September 1999), pp. 201-205.
Intravenous magnesium sulfate treatment for acute asthma in the emergency department: a systematic review of the literature.: Annals of emergency medicine, Vol. 36, No. 3. (September 2000), pp. 181-190.STUDY OBJECTIVES: There is some evidence that magnesium, when infused into asthmatic patients, can produce bronchodilatio n in addition to that obtained from standard treatments. This systematic review examined the effect of intravenous magnesium sulfate used for patients with acute asthma managed in the emergency department. METHODS: Only randomized controlled trials were eligible for inclusion. Studies were included if patients presented with acute asthma and were treated with intravenous magnesium sulfate versus placebo. Trials were identified from the Cochrane Airways Review Group register, which consists of a combined search of EMBASE, MEDLINE, and CINAHL databases and hand-searching of 20 key respiratory journals. Bibliographies from included studies and known reviews were searched. Primary authors and content experts were contacted. Data were extracted and methodologic quality was assessed independently by 2 reviewers. Missing data were obtained from authors. RESULTS: Seven trials (5 adult, 2 pediatric) involving a total of 668 patients were included. Overall, admission to hospital was not statistically reduced using magnesium sulfate (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.09 to 1.02). In the severe subgroup, admissions were reduced in those receiving magnesium sulfate (OR 0.10, 95% CI 0.04 to 0.27). Overall, patients receiving magnesium sulfate demonstrated nonsignificant improvements in peak expiratory flow rates (PEFR) when all studies were pooled (weighted mean difference [WMD] 29 L/min, 95% CI -3 to 62). In studies of patients with severe acute asthma, PEFR WMD improved by 52 L/min (95% CI 27 to 78) favoring magnesium sulfate treatment. The absolute FEV(1) also improved by 10% predicted (95% CI 4 to 16) in patients with severe acute asthma. No clinically important changes in vital signs or side effects were reported. CONCLUSION: Current evidence does not clearly support routine use of intravenous magnesium sulfate in all patients with acute asthma presenting to the ED. However, magnesium sulfate appears to be safe and beneficial for patients who present with severe acute asthma. Practice guidelines need to be changed to reflect these results.BH Rowe, JA Bretzlaff, C Bourdon, GW Bota, CA Camargo

Source: Annals of emergency medicine, Vol. 36, No. 3. (September 2000), pp. 181-190.

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