Incarcerated internal hernia of the small intestine through a breach of the broad ligament: two cases and a literature review.

Two cases of internal herniation through a defect in the broad ligament of the uterus are described. Both were successfully treated laparoscopically. This rare condition should be borne in mind when a middle-aged woman presents with colicky lower abdominal pain. The cause is unknown, but both congenital and acquired origins have been proposed. As far as emergency situations are concerned, laparoscopy has proven to be both a diagnostic and a therapeutic tool.     

Carotid sinus nerve blockade to reduce blood pressure instability following carotid endarterectomy: a systematic review and meta-analysis.

OBJECTIVES: Local anaesthetic infiltration into the carotid sinus during carotid endarterectomy (CEA) has been recommended to minimise blood pressure fluctuations but its use remains controversial. The aim of this meta-analysis was to determine whether intra-operative administration of local anaesthetic reduces the incidence of haemodynamic instability following CEA. MATERIALS AND METHODS: A search of the Medline, Pubmed and Embase databases and the Current Controlled Trials register identified four trials, which met the pre-defined inclusion criteria for data extraction. Pooled odds ratios with 95 per cent confidence intervals (c.i.) for the development of post-operative hypotension and hypertension were calculated using a random-effects model. RESULTS: Outcomes of 432 patients were studied. Local anaesthetic blockade of the carotid sinus was associated with a pooled odds ratio of 1.25 (95 per cent c.i. 0.496 to 3.15); p=0.216) and 1.28 (95 per cent c.i. 0.699 to 2.33; p=0.428) for the development of post-operative hypotension and hypertension respectively. Although none reach significance there was a trend towards increased risk of developing a complication in those patients who received local anaesthetic. CONCLUSIONS: There are insufficient data to determine the role of intra-operative local anaesthetic administration in reducing post-operative blood pressure lability following CEA. Conversely, the possibility of harm cannot be excluded on the basis of the currently available data.     

Präklinische Intubation

Endotracheal intubation is required in 5–10% of all prehospital emergencies. Poor environmental conditions (e.g. limited space, poor or excessive lighting etc.), unfavorable patient-related factors (e.g. trauma, bleeding, pulmonary aspiration etc.) and the pressure of time make prehospital airway management a challenging procedure even for experienced emergency physicians. The incidence of difficult endotracheal intubation is significantly higher than in-hospital. Profound clinical practice, recognition and adequate treatment of complications of intubation, and ongoing clinical practice are essential for successful and responsible prehospital airway management. A brief physical examination helps to identify predictors for difficult intubation, thereby modifying treatment strategies. Every emergency physician must be closely familiar with at least one supraglottic airway device and the recent algorithms to manage the unanticipated difficult airway.