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Emerg Med J. 2007 December; 24(12): 864.
PMCID: PMC2658371

Emq Answers

Answer 1

Theme: Treatment strategies

  1. True. It may reverse the confusion temporarily allowing you to elicit a better history and explore consent issues. However, it may lower the patient's fitting threshold.1
  2. True. And readily available!2
  3. True. In one large non‐randomised trial the rates of recovery at 6 months were 91% (prednisolone) versus 100% (prednisolone plus aciclovir) if the treatment was started within 3 days. The dose schedules were: a 10‐day course of 1 mg/kg per day of prednisolone, and a 7‐day course of 2000 mg/day of aciclovir.3
  4. False.4

Answer 2

Theme: Ketamine

  1. False. It does reduce hypersalivation but this is of no clinical consequence.5
  2. False.6,7 Consider using it reactively in the rare circumstance of a significant emergence problem.
  3. True.8
  4. False. Pulse oximetry and direct observation alone are sufficient.9

Answer 3

Theme: Propofol

  1. False. It may be considered as a treatment for refractory status epilepsy.10
  2. True. The propofol data sheet that accompanies the vials also lists purified egg as a listed ingredient in the emulsion. Egg allergy is also a contraindication.
  3. True.11
  4. False. Injection site pain is uncommon (2–20% in existing emergency department reports).11 Use lignocaine at your discretion.


1. Lock B G, Pandit K. Is flumazenil an effective treatment for hepatic encephalopathy? Ann Emerg Med 2006. 47286–288.288 [PubMed]
2. Fogan L. Treatment of cluster headache: a double‐blind comparison of oxygen v air inhalation. Arch Neurol 1985. 42362–363.363 [PubMed]
3. Hato N, Matsumoto S, Kisaki H. et al Efficacy of early treatment of Bell's palsy with oral acyclovir and prednisolone. Otol Neurotol 2003. 24948–951.951 [PubMed]
4. Wenzel V, Krismer A C, Arntz H R. et al A comparison of vasopressin and epinephrine for out‐of‐hospital cardiopulmonary resuscitation. N Engl J Med 2004. 350105–113.113 [PubMed]
5. Heinz P, Geelhoed G C, Wee C. et al Is atropine needed with ketamine sedation? A prospective, randomised, double blind study. Emerg Med J 2006. 23206–209.209 [PMC free article] [PubMed]
6. Wathen J E, Roback M G, Mackenzie T. et al Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double‐blind, randomized, controlled emergency department study. Ann Emerg Med 2000. 3679–88.88 [PubMed]
7. Sherwin T S, Green S M, Khan A. et al Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures? A randomized, double‐blind, placebo‐ controlled trial. Ann Emerg Med 2000. 35229–238.238 [PubMed]
8. Green S, Krauss B. Should I give ketamine IV or IM? Ann Emerg Med 2006. 48613–614.614 [PubMed]
9. Godwin S, Caro D A, Wolf S J. et al Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med 2005. 45177–196.196 [PubMed]
10. BestBETs Propofol for status epilepticus. Available at‐bin/ = 00298 (accessed 10 October 2007)
11. Minor J R, Burton J H. Clinical practice advisory: emergency department procedural sedation with propofol. Ann Emerg Med 2007. 50182–187.187 [PubMed]

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