ABSTRACT
OBJECTIVE: To determine practice and attitudes of emergency physicians regarding procedural anaesthesia for nasogastric tube insertion (NGT). METHODS: Survey of resident/attending emergency physicians working in a tertiary care medical centre. RESULTS: Of 68 physicians, 46 responded: 98% believed that awake and alert patients find NGT insertion uncomfortable/painful; 93% used measures to reduce this, most commonly lubricant gel, topical anaesthetic spray, lidocaine gel, and distraction/use of a child life worker; 28% believed these provided adequate pain control and 37% believed they were inadequate. Topical anaesthetic spray, lidocaine gel, and nebulised/atomised anaesthetics were believed the most practical to administer and 44% actually used these. Nebulised/atomised anaesthetics, systemic anxiolytics, and topical anaesthetic spray were believed the most effective at pain control but only 24% actually used these. While 39% of respondents were satisfied with their current practice, 46% were dissatisfied: 91% would change their practice if new literature were to show a convenient way to effectively reduce this pain. CONCLUSIONS: Emergency physicians do not actually use the measures they believe are most practical/most effective at reducing the pain associated with NGT insertion. Thus, there may be a barrier to the use of these measures. Improvement in procedural anaesthesia for NGT insertion in emergency departments is needed and desired by emergency physicians.
Subject(s)
Anesthesia/methods , Clinical Competence , Emergency Medicine/standards , Intubation, Gastrointestinal/psychology , Administration, Topical , Anesthetics/administration & dosage , Attitude of Health Personnel , Emergencies , Gels , Humans , Intubation, Gastrointestinal/adverse effects , Intubation, Gastrointestinal/standards , Lidocaine/administration & dosage , Pain/prevention & controlABSTRACT
OBJECTIVE: To evaluate the effectiveness of ankle-foot orthoses (AFOs) in spastic diplegic cerebral palsy patients for whom orthoses were indicated to control equinus or pes planovalgus deformities. DESIGN: A retrospective, cross-sectional assessment was performed on diplegic subjects who had suitable barefoot and AFO gait trials on the same day. PATIENTS: Thirty-five subjects with a mean age of 8.7 yrs were included. Eighteen wore braces to control equinus and 17 to control pes planovalgus and crouch. OUTCOME MEASURES: Gait data assessed in all subjects included temporal-distance factors and sagittal kinematics. Force plate data to determine joint moments and powers were obtained in 20. Repeated measures analysis of variance was used to compare across conditions and indications. RESULTS: The cohort demonstrated increased velocity (10 cm/sec; p < .001), stride length (10 cm; p < .001), and percent single-limb support (1.8%; p < .002) using AFOs compared with barefoot gait. In braces, ankle excursion was reduced (p < .0001), while pelvic, hip, and knee excursions were increased to account for the temporal changes (p < .009). Effects were similar in both indication groups. In neither indication group did the AFO significantly alter knee position in stance. Kinetic analysis showed a reduction of abnormal power burst (p < .05) in early stance and an increase in late stance ankle moment (p < .05) with AFOs. Differences in gait characteristics and bracing effects are shown for both indication groups. CONCLUSION: Compared with barefoot gait, AFOs enhanced gait function in diplegic subjects. Benefits resulted from elimination of premature plantar flexion and improved progression of foot contact during stance. Effects on proximal joint alignment were not significant.
