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Emergency Medicine Journal: EMJ

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https://www.readbyqxmd.com/read/29141907/emergency-versus-standard-response-time-efficacy-of-london-s-air-ambulance-rapid-response-vehicle
#1
Marius Rehn, Gareth Davies, Paul Smith, David Lockey
OBJECTIVE: The potential increased risk of an emergency response using a rapid response vehicle (RRV) should only be accepted when it allows a clinically significant time saving for management of patients who are critically injured or sick. Air ambulance services often use an RRV to maintain operational resilience. We compared the RRV response time on emergency versus standard driving to inform emergency services of time efficacy of emergency response in an urban environment. METHODS: Prospective observational controlled study of response data of emergency and standard driving...
November 15, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29127102/algorithms-to-guide-ambulance-clinicians-in-the-management-of-emergencies-in-patients-with-implanted-rotary-left-ventricular-assist-devices
#2
REVIEW
Christopher T Bowles, Rachel Hards, Neil Wrightson, Paul Lincoln, Shishir Kore, Laura Marley, Jonathan R Dalzell, Binu Raj, Tracey A Baker, Diane Goodwin, Petra Carroll, Jane Pateman, John J M Black, Paul Kattenhorn, Mark Faulkner, Jayan Parameshwar, Charles Butcher, Mark Mason, Alexander Rosenberg, Ian McGovern, Alexander Weymann, Carl Gwinnutt, Nicholas R Banner, Stephan Schueler, Andre R Simon, David W Pitcher
Advances in left ventricular assist device (LVAD) therapy have resulted in increasing numbers of adult LVAD recipients in the community. However, device failure, stroke, bleeding, LVAD thrombosis and systemic infection can be life-threatening emergencies. Currently, four LVAD systems are implanted in six UK transplant centres, each of which provides device-specific information to local emergency services. This has resulted in inconsistent availability and content of information with the risks of delayed or inappropriate decision-making...
November 10, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29122826/digging-deep
#3
EDITORIAL
Jill M Huded, Todd I Smith
No abstract text is available yet for this article.
November 9, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29117989/elevated-mortality-among-weekend-hospital-admissions-is-not-associated-with-adoption-of-seven-day-clinical-standards
#4
Rachel Meacock, Matt Sutton
INTRODUCTION: Patients admitted to hospital in an emergency at weekends have been found to experience higher mortality rates than those admitted during the week. The National Health Service (NHS) in England has introduced four priority clinical standards for emergency hospital care with the objective of reducing deaths associated with this 'weekend effect'. This study aimed to determine whether adoption of these clinical standards is associated with the extent to which weekend mortality is elevated...
November 8, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29102923/a-traumatic-tale-of-two-cities-does-ems-level-of-care-and-transportation-model-affect-survival-in-patients-with-trauma-at-level-1-trauma-centres-in-two-neighbouring-canadian-provinces
#5
Colin Rouse, Jefferson Hayre, James French, Jacqueline Fraser, Ian Watson, Susan Benjamin, Allison Chisholm, Beth Sealy, Mete Erdogan, Robert S Green, George Stoica, Paul Atkinson
BACKGROUND: Two distinct Emergency Medical Services (EMS) systems exist in Atlantic Canada. Nova Scotia operates an Advanced Emergency Medical System (AEMS) and New Brunswick operates a Basic Emergency Medical System (BEMS). We sought to determine if survival rates differed between the two systems. METHODS: This study examined patients with trauma who were transported directly to a level 1 trauma centre in New Brunswick or Nova Scotia between 1 April 2011 and 31 March 2013...
November 4, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29084730/calculating-the-proportion-of-avoidable-attendances-at-uk-emergency-departments-analysis-of-the-royal-college-of-emergency-medicine-s-sentinel-site-survey-data
#6
Toby Morris, Suzanne M Mason, Chris Moulton, Colin O'Keeffe
INTRODUCTION: Avoidable attendances (AAs; defined as non-urgent, self-referred patients who could be managed more effectively and efficiently by other services) have been identified as a contributor to ED crowding. Internationally, AAs have been estimated to constitute 10%-90% of ED attendances, with the UK 2013 Urgent and Emergency Care Review suggesting a figure of 40%. METHODS: This pilot study used data from the Royal College of Emergency Medicine's Sentinel Site Survey to estimate the proportion of AAs in 12 EDs across England on a standard day (20 March 2014)...
October 30, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29055893/tackling-the-demand-for-emergency-department-services-there-are-no-silver-bullets
#7
EDITORIAL
Mathew Mercuri, Shawn E Mondoux
No abstract text is available yet for this article.
October 21, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29055892/perceived-support-at-work-after-critical-incidents-and-its-relation-to-psychological-distress-a-survey-among-prehospital-providers
#8
Juul Gouweloos-Trines, Mark P Tyler, Melita J Giummarra, Nancy Kassam-Adams, Markus A Landolt, Rolf J Kleber, Eva Alisic
INTRODUCTION: Prehospital providers are at increased risk for psychological distress. Support at work after critical incidents is believed to be important for providers, but current guidelines are in need of more scientific evidence. This study aimed to investigate: (1) to what extent prehospital providers experience support at work; (2) whether support at work is directly associated with lower distress and (3) whether availability of a formal peer support system is related to lower distress via perceived colleague support...
October 21, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29055891/using-an-alumni-survey-to-target-improvements-in-an-emergency-medicine-training-programme
#9
Theodore Gaeta, Gowtham Mahalingam, Matthew Pyle, Aaron Dam, Annette Visconti
INTRODUCTION: The Accreditation Council for Graduate Medical Education (ACGME) is the governing body responsible for accrediting graduate medical training programme in the USA. The Emergency Medicine Milestones (EM-Milestones) were developed by the ACGME and American Board of Emergency Medicine as a guide and monitoring tool for the knowledge, skills, abilities and experiences to be acquired during training. Alumni surveys have been reported as a valuable resource for training programme to identify areas for improvement; however, there are few studies regarding programme improvement in emergency medicine...
October 21, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29055890/utility-of-prehospital-electrocardiogram-characteristics-as-prognostic-markers-in-out-of-hospital-pulseless-electrical-activity-arrests
#10
Michael L Ho, Mathieu Gatien, Christian Vaillancourt, Veronica Whitham, Ian G Stiell
BACKGROUND: It is unclear if there are predictors of survival, including ECG characteristics, that can guide resuscitative efforts in pulseless electrical activity (PEA) cardiac arrests. We studied the predictive potential of presenting prehospital ECGs on survival for patients with out-of-hospital cardiac arrest (OHCA) with PEA. METHODS: We studied prehospital ECGs of patients with OHCA prospectively enrolled between June 2007 and November 2009 at the Ottawa/OPALS (Ontario Prehospital Advanced Life Support Study) site of the Resuscitation Outcomes Consortium PRIMED study (Prehospital Resuscitation using an IMpedance valve and Early versus Delayed analysis)...
October 21, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29025864/pre-emptive-ice-cube-cryotherapy-for-reducing-pain-from-local-anaesthetic-injections-for-simple-lacerations-a-randomised-controlled-trial
#11
JaeWoo Song, HyukHoon Kim, EunJung Park, Jung Hwan Ahn, Eunhui Yoon, Samsun Lampotang, Nikolaus Gravenstein, SangChun Choi
OBJECTIVE: Subcutaneous local anaesthetic injection can be painful to patients in the ED. We evaluated the effect of cryotherapy by application of an ice cube to the injection site prior to injection in patients with simple lacerations. METHODS: We conducted a prospective, randomised, controlled trial in consented patients with simple lacerations needing primary repair at a single emergency centre from April to July 2016. We randomly assigned patients undergoing repair for simple lacerations to either the cryotherapy group or the control group (standard care; no cryotherapy or other pretreatment of the injection site)...
October 12, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29025863/are-rising-admission-thresholds-good-medicine
#12
EDITORIAL
Adrian A Boyle, Ellen J Weber
No abstract text is available yet for this article.
October 12, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29018000/waveform-capnography-an-alternative-to-physician-gestalt-in-determining-optimal-intubating-conditions-after-administration-of-paralytic-agents
#13
Anthony Scoccimarro, Jason R West, Marc Kanter, Nicholas D Caputo
PURPOSE: We sought to evaluate the utility of waveform capnography (WC) in detecting paralysis, by using apnoea as a surrogate determinant, as compared with clinical gestalt during rapid sequence intubation. Additionally, we sought to determine if this improves the time to intubation and first pass success rates through more consistent and expedient means of detecting optimal intubating conditions (ie, paralysis). METHODS: A prospective observational cohort study of consecutively enrolled patients was conducted from April to June 2016 at an academic, urban, level 1 trauma centre in New York City...
October 10, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28978652/evaluating-an-admission-avoidance-pathway-for-children-in-the-emergency-department-outpatient-intravenous-antibiotics-for-moderate-severe-cellulitis
#14
Laila F Ibrahim, Sandy M Hopper, Tom G Connell, Andrew J Daley, Penelope A Bryant, Franz E Babl
OBJECTIVE: Children with moderate/severe cellulitis requiring intravenous antibiotics are usually admitted to hospital. Admission avoidance is attractive but there are few data in children. We implemented a new pathway for children to be treated with intravenous antibiotics at home and aimed to describe the characteristics of patients treated on this pathway and in hospital and to evaluate the outcomes. METHODS: This is a prospective, observational cohort study of children aged 6 months-18 years attending the ED with uncomplicated moderate/severe cellulitis in March 2014-January 2015...
October 4, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28971848/emergency-consultants-value-medical-scribes-and-most-prefer-to-work-with-them-a-few-would-rather-not-a-qualitative-australian-study
#15
Timothy Luke Cowan, William A Dunlop, Michael Ben-Meir, Margaret Staples, Ainsley Treadwell, Eliza Gardner-Brunton, Katherine Justice Walker
OBJECTIVE: The utilisation of medical scribes in the USA has enabled productivity gains for emergency consultants, though their personal experiences have not been widely documented. We aimed to evaluate the consultant experience of working with scribes in an Australian ED. METHODS: Emergency consultants working with scribes and those who declined to work with scribes were invited to participate in individual interviews (structured and semistructured questions) about scribes, scribe work and the scribe program in October 2016...
September 29, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28971847/the-civilian-validation-of-the-modified-physiological-triage-tool-mptt-an-evidence-based-approach-to-primary-major-incident-triage
#16
James Vassallo, Jason Smith, Omar Bouamra, Fiona Lecky, Lee A Wallis
INTRODUCTION: Triage is a key principle in the effective management of a major incident. Existing triage tools have demonstrated limited performance at predicting need for life-saving intervention (LSI). Derived on a military cohort, the Modified Physiological Triage Tool (MPTT) has demonstrated improved performance. Using a civilian trauma registry, this study aimed to validate the MPTT in a civilian environment. METHODS: Retrospective database review of the Trauma Audit and Research Network (TARN) database for all adult patients (>18 years) between 2006 and 2014...
September 29, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28899923/a-retrospective-analysis-of-34-potentially-missed-cases-of-female-genital-mutilation-in-the-emergency-department
#17
Richard John Fawcett, George Kernohan
OBJECTIVES: To discover if healthcare professionals working within an ED are able to make a diagnosis of female genital mutilation (FGM) in those patients who have previously undergone the procedure and report it as per UK law. DESIGN: A retrospective analysis of patients' notes who were assigned an FGM code during the period of May 2015 to August 2016. SETTING: Single-centre, large UK major trauma centre offering a tertiary FGM clinic. PARTICIPANTS: Any woman coded during the study period as having undergone FGM...
September 12, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28899922/changes-in-admission-thresholds-in-english-emergency-departments
#18
Steven Wyatt, Kieran Child, Andrew Hood, Matthew Cooke, Mohammed A Mohammed
BACKGROUND: The most common route to a hospital bed in an emergency is via an Emergency Department (ED). Many recent initiatives and interventions have the objective of reducing the number of unnecessary emergency admissions. We aimed to assess whether ED admission thresholds had changed over time taking account of the casemix of patients arriving at ED. METHODS: We conducted a retrospective cross-sectional analysis of more than 20 million attendances at 47 consultant-led EDs in England between April 2010 and March 2015...
September 12, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28870995/one-hundred-years-on-ypres-and-atls
#19
Rachael Sv Parker, Paul J Parker
No abstract text is available yet for this article.
September 4, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28860179/fewer-reboa-complications-with-smaller-devices-and-partial-occlusion-evidence-from-a-multicentre-registry-in-japan
#20
Yosuke Matsumura, Junichi Matsumoto, Hiroshi Kondo, Koji Idoguchi, Tokiya Ishida, Yuri Kon, Keisuke Tomita, Kenichiro Ishida, Tomoya Hirose, Kensuke Umakoshi, Tomohiro Funabiki
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) performed by emergency physicians has been gaining acceptance as a less invasive technique than resuscitative thoracotomy. OBJECTIVE: To evaluate access-related complications and duration of occlusions during REBOA. METHODS: Patients with haemorrhagic shock requiring REBOA, from 18 hospitals in Japan, included in the DIRECT-IABO Registry were studied. REBOA-related characteristics were compared between non-survivors and survivors at 24 hours...
August 31, 2017: Emergency Medicine Journal: EMJ
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