Journal reviews: LET vs. EMLA for pretreating lacerations; drowning prevention information; family presence
Singer AJ, Stark MJ. LET vs. EMLA for pretreating lacerations: A randomized trial. Acad Emerg Med 2001; 3:223-230.
A topical lidocaine-epinephrine-tetracaine (LET) gel is the most effective anesthetic for repair of lacerations, says this study from State University of New York at Stony Brook. Sixty patients with uncomplicated, clean traumatic lacerations were given EMLA (eutectic mixture of local anesthetics) cream or LET solution prior to lidocaine injection. Both creams were applied as soon as the patients presented to the triage desk.
The study showed that patients pretreated with LET and EMLA experienced similar reduction of pain with local infiltration of lidocaine. Here are key differences between LET and EMLA that the researchers noted:
• EMLA cream has a slower rate of absorption and onset of anesthesia: approximately one hour compared to 15-30 minutes for LET.
• Early application of LET at triage can reduce the patient’s length of stay.
• LET is not contraindicated in open wounds.
• LET is considerably less expensive than EMLA ($1-$2 vs. $8-$16, respectively).
• Topical application of EMLA cream may be associated with rare occurrences of methemoglobinemia.
For the above reasons, the researchers recommend LET as the preferred topical anesthetic.
Quan L, Bennett E, Cummings P, et al. Do parents value drowning prevention information at discharge from the emergency department? Ann Emerg Med 2001; 37:382-385.
Parents bringing children to the ED were receptive to receiving written drowning prevention messages and were able to recall the material afterward, according to this study from the University of Washington School, Children’s Hospital and Regional Medical Center, and Harborview Injury Prevention and Research Center, all in Seattle.
Parents were given computerized discharge instructions that included three prevention messages: wear a life vest, swim in safe areas, and do not drink alcohol while swimming or boating. Parents were contacted by telephone one to two weeks after the visit and asked to recall the prevention messages and rate the usefulness of the instructions.
Of the 619 parents who completed the interview, 50% recalled receiving the information. When asked what the message was about, 41% recalled the life vest messages, 25% recalled the message about drowning risks, and 13% recalled the message about swimming. Of the 155 parents who did not own a life vest, 35% said they would consider buying one for their child because of the information they received. Most parents (88%) said the prevention information was useful or very useful.
Families should receive injury prevention information from multiple sources, including the ED, argue the researchers. They point to new technologies, such as computerized discharge instructions, and a trend toward increased patient interest in health information, both of which enable ED staff to educate large numbers of patients with no additional burden. "The role of the ED in injury prevention has been envisioned as a surveillance tool, but this role can be expanded," they wrote.
Eichhorn DJ, Meyers TA, Guzzetta CE, et al. Family presence during invasive procedures and resuscitation: Hearing the voice of the patient. Am J Nurs 2001; 101:48-53.
Patients universally say that having a family member present was beneficial during invasive procedures, says this study from Presbyterian Hospital of Dallas. A total of 43 patients who survived invasive procedures or cardiopulmonary resuscitation with family presence were interviewed two months after the procedure. Each interview was taped and transcribed in order to find common themes.
Some of the key themes that emerged included the benefits of being comforted by a family member, an understanding of how family presence helps the family remain intact as a unit during a crisis, and the belief that family presence is a right held by both patients and families.
All of the patients interviewed for the study found that family presence was beneficial. "Family members acted as immediate patient advocates and expressed caring. Patients reported that by doing so, family members helped them understand, cope with, and reframe painful and stressful events," wrote the researchers.
Although the study was designed to report both positive and negative opinions about the practice, all the patients found family visitation to be helpful and there were no negative findings. In fact, because of the many benefits they received from family presence, all of the interviewed patients believed it to be their right during acute events.
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