RESUMO
Procedural sedation is essential in the ED to conduct painful procedures effectively. Ketamine and benzodiazepines/opioids are commonly used, with ketamine providing adequate analgesia and preserving airway muscle tone. However, ketamine is associated with adverse effects while benzodiazepines/opioids can lead to respiratory depression. This study compares the safety and efficacy of ketamine and midazolam/fentanyl. Two search methods were used to identify studies related to our topic, including a database search and a manual search involving screening reference lists of articles retrieved by the database search. A methodological quality appraisal was conducted on the articles suitable for inclusion using Cochrane's risk of bias tool in the Review Manager software (Review Manager (RevMan) (Computer program). Version 5.4, The Cochrane Collaboration, 2020). Moreover, pooled analysis was performed using the Review manager software. The study analyzed 1366 articles, of which seven were included for analysis. Pooled data showed that ketamine and midazolam/fentanyl had similar effects on pain scores during procedures and sedation depth measured by the University of Michigan sedation scale. However, the Modified Ramsay Sedation Score showed significantly more profound sedation in the ketamine group. The only significant adverse events were vomiting and nausea, which had a higher incidence in the ketamine group. Our data suggest that ketamine is as effective as the midazolam/fentanyl combination for procedural sedation but is associated with higher incidences of adverse events. Therefore, midazolam/fentanyl can be recommended for procedural sedation in the ED. However, it should be provided in the presence of a physician comfortable with airway management due to high incidences of oxygen desaturation.
RESUMO
The United Arab Emirates (UAE) has experienced substantial development in infrastructure and transportation in the last few decades. Although available evidence suggests that the incidence of injuries has considerably increased in the previous few years, there is a scarcity of literature that comprehensively analyzed the mortality due to different types of injuries in the UAE. Therefore, the current study was designed to report mortality due to various intentional and unintentional injuries in the UAE. Secondary data was obtained from the World Health Organization (WHO) mortality database. We targeted injuries-specific mortality datasets. We applied a filter (UAE) to retrieve mortality data from unintentional and intentional injuries in the UAE. The latest data in the WHO mortality database was for 2020-21. A total of 10,357 death records from the UAE were present in the WHO mortality database. The percentage of injury-specific deaths out of total deaths was 8.69% (n=900). Injury-specific mortality rate per 100,000 population was 9.09. The percentage of injury-specific deaths was higher for males (87.3%, n=786) and the age group 25-34 years (n=323, 35.9%). Of the 900 injury-specific deaths, 449 (49.9%) were due to unintentional injuries, 216 (24.0%) were due to unintentional injuries, while the remaining (26.1%, n=235) deaths occurred due to Ill-defined injuries. More than half (53.7%, n=241) of unintentional injuries were because of road traffic injuries (RTIs) followed by fall (14.7%, n=66), exposure to mechanical forces (6.5%, n=29), drowning (6.0%, n=27) fire (1.1%, n=5), poisonings (1.1%, n=5), natural disasters (n=1, 0.2%) and other unintentional injuries (16.7%, n=75). More than three-quarters (83.3%, n=180) of intentional injuries were because of self-inflicted injuries while the remaining (16.7%, n=36) intentional injuries-specific deaths occurred due to violence. Many deaths in the UAE occur due to unintentional and intentional injuries. RTIs and falls are the leading causes of unintentional injury-specific deaths, while self-inflicted injuries and violence are the leading causes of intentional injury-specific deaths.