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author:("mosso, David")
1.  Propofol for procedural sedation in the emergency department 
Emergency Medicine Journal : EMJ  2007;24(7):459-461.
To observe procedural sedation practice within a district general hospital emergency department (ED) that uses propofol for procedural sedation.
Prospective observation of procedural sedation over an 11 month period. Patients over 16 years of age requiring procedural sedation and able to give informed consent were recruited. The choice of sedation agent was at the discretion of the physician. The following details were recorded on a standard proforma for each patient: indication for procedural sedation; agent used; depth and duration of sedation; ease of reduction; use of a reversal agent; complications and reasons for delayed discharge from the ED.
48 patients were recruited; propofol was used in 32 cases and midazolam in 16 cases. The median period of sedation was considerably shorter in the propofol group (3 vs 45 min) but this did not confer a shorter median time in the ED (200 vs 175 min). There were no documented cases of over‐sedation in the propofol group; however, four patients in the midazolam group were over‐sedated, three requiring reversal with flumazenil. There were no other significant complications in either group. There was no difference in the median depth of sedation achieved or ease of reduction between the two groups.
Propofol is effective and safe for procedural sedation in the ED. Propofol has a considerably shorter duration of action than midazolam, thereby shortening the period of sedation.
PMCID: PMC2658387  PMID: 17582032
2.  The use of skull X-rays in head injury in the emergency department--a changing practice. 
INTRODUCTION: This is a consequential study of a previous audit, evaluating the role of skull X-rays in the emergency department in patients with head injuries, to see if the changes recommended, (implementation of The Royal College of Surgeons of England guidelines) have been adopted successfully and had the desired result. PATIENTS & METHODS: All patients who attended the accident and emergency department at the Royal Berkshire Hospital from 1-30 November 2003 with a diagnosis of head injury had their notes analysed for indications for skull X-ray, presence of fracture and outcome. RESULTS: 278 patients were identified as having a head injury and had notes available, 19% (54/278) of these patients had a skull X-ray, of whom 31% (17/54) had a clearly documented indication. This shows a marked improvement from the previous audit when 50% (193/385) had a skull X-ray with only 7% (14/193) having a clearly documented indication. DISCUSSION: Following the introduction of new guidelines, a clear improvement in the practice of evidence-based medicine has been achieved; however, there is still room for further improvement and on-going education of staff and auditing of performance will help to ensure this continues.
PMCID: PMC1963902  PMID: 15901380

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