Stopping Haemorrhage by Application of Rope tourniquet or inguinal Compression (SHARC study).

OBJECTIVE: There are increasing numbers of shark attacks in Australasian waters, with death commonly resulting from uncontrolled lower limb bleeding. The present study aims to determine the most effective first aid method using immediately available resources for controlling lower limb haemorrhage, which could be provided by single unsupported rescuer. METHODS: The present study was a clinical trial performed at a single tertiary referral hospital. Healthy volunteers who completed a screening questionnaire, a baseline popliteal velocity measurement and then consented were eligible. The present study used Doppler ultrasound to record the reduction in popliteal artery peak systolic velocity created by surfboard leg rope tourniquet and by inguinal region external compression in healthy volunteer subjects with and without a wetsuit. Leg circumference and sex data were also collected. RESULTS: Pooled data from each intervention without and with a wetsuit showed that inguinal compression resulted in a mean reduction of popliteal artery peak systolic velocity of 89.7% (95% CI 83.9%, 95.5%) compared to leg rope application 43.8% (95% CI 34.5%, 53.1%; P ≤ 0.001). There was no significant influence by the wetsuit on effectiveness of either intervention technique. CONCLUSION: The present study has shown that manual inguinal compression, an easily taught first aid technique, can reliably completely stop or substantially reduce blood loss in the setting of a lower limb injury and is superior to an improvised tourniquet.

Review article: Safety profile of propofol for paediatric procedural sedation in the emergency department.

The use of propofol for paediatric procedural sedation (PPS) is increasing because of its favourable pharmacodynamic profile. Its paediatric use has been limited in some ED (emergency departments) because of the perceived high rate of serious adverse events in comparison with other sedation agents. A systematic literature review of propofol use for PPS outside the operating theatre environment from 1966 to 2008 was carried out to profile the adverse event rate in comparison with other procedural sedation agents. Sixty studies with a total of 17,066 paediatric propofol sedations in a variety of hospital settings were identified. The incidence of complications were: desaturation 9.3%, apnoea 1.9%, assisted ventilation 1.4%, hypotension 15.4%, unplanned intubation 0.02%, emesis post procedure 0.14%, laryngospasm 0.1% and bradycardia 0.1%. There were no reported incidents of aspiration or emesis during sedation and there were no deaths associated with procedural propofol sedation. The use of propofol for PPS is associated with a low rate of minor adverse events that are all reversible with minimal intervention and do not produce long-term sequelae and occur at similar rates to minor adverse events experienced with other sedation agents. Major adverse events with propofol sedation are extremely rare and appropriate patient and procedure selection would decrease these risks further. The increasing use of propofol for ED PPS is supported by the current evidence because of its comparable adverse event rate to other agents.