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BMC Emergency Medicine

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https://www.readbyqxmd.com/read/29347913/an-unusual-case-of-infective-pneumocephalus-case-report-of-pneumocephalus-exacerbated-by-continuous-positive-airway-pressure
#1
Abdus Samad Ansari, Brittany B Dennis, Dilip Shah, Winfred Baah
BACKGROUND: Pneumocephalus, illustrated by air in the cranial vault is relatively infrequent and generally associated with neurosurgery, trauma, meningitis and barotrauma. However cases of spontaneous non-traumatic pneumocephalus remain rare. While the relationship between continuous positive airway pressure (CPAP) and atraumatic pneumocephalus has been previously reported, to our knowledge the rare presentation associated with sinus wall osteomyelitis has never been described. We summarize here the case of a 67-year-old woman's acute presentation of Streptococcus salvarius infection after a sudden drop in her consciousness...
January 18, 2018: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29347908/management-and-outcomes-of-patients-presenting-with-sepsis-and-septic-shock-to-the-emergency-department-during-nursing-handover-a-retrospective-cohort-study
#2
Sami Alsolamy, Atheer Al-Sabhan, Najla Alassim, Musharaf Sadat, Eman Al Qasim, Hani Tamim, Yaseen M Arabi
BACKGROUND: Clinical handover is an important process for the transition of patient-care responsibility to the next healthcare provider, but it may divert the attention of the team away from active patients. This is challenging in the Emergency Department (ED) because of highly dynamic patient conditions and is likely relevant in conditions that requires time-sensitive therapies, such as sepsis. We aimed to examine the management and outcomes of patients presenting with sepsis and septic shock to the ED during nursing handover...
January 18, 2018: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29334925/implementing-blended-learning-in-emergency-airway-management-training-a-randomized-controlled-trial
#3
Madeleine Huei Tze Kho, Keng Sheng Chew, Muhaimin Noor Azhar, Mohd Lotfi Hamzah, Kee Man Chuah, Aida Bustam, Hiang Chuan Chan
BACKGROUND: While emergency airway management training is conventionally conducted via face-to-face learning (F2FL) workshops, there are inherent cost, time, place and manpower limitations in running such workshops. Blended learning (BL) refers to the systematic integration of online and face-to-face learning aimed to facilitate complex thinking skills and flexible participation at a reduced financial, time and manpower cost. This study was conducted to evaluate its effectiveness in emergency airway management training...
January 15, 2018: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29273012/a-prospective-observational-cohort-study-of-patients-presenting-to-an-emergency-department-with-acute-shoulder-trauma-the-manchester-emergency-shoulder-mesh-project
#4
Michael J Callaghan, Janos P Baombe, Dan Horner, Charles E Hutchinson, Dilraj Sandher, Simon Carley
BACKGROUND: Fracture and dislocation of the shoulder are usually identifiable through the use of plain radiographs in an emergency department. However, other significant soft tissue injuries can be missed at initial presentation. This study used contrast enhanced magnetic resonance arthrography (MRA) to determine the pattern of underlying soft tissue injuries in patients with traumatic shoulder injury, loss of active range of motion, and normal plain radiography. METHODS: A prospective, observational cohort study...
December 22, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29237400/accuracy-of-acute-burns-diagnosis-made-using-smartphones-and-tablets-a-questionnaire-based-study-among-medical-experts
#5
Lisa Blom, Constance Boissin, Nikki Allorto, Lee Wallis, Marie Hasselberg, Lucie Laflamme
BACKGROUND: Remote assistance for burns by medical experts can support nurses and general physicians in emergency care with diagnostic and management advice. Previous studies indicate a high diagnostic accuracy based on images viewed on a computer screen, but whether image-based analysis by experts using handheld devices is accurate remains to be determined. METHOD: A review of patient data from eight emergency centres in the Western Cape, South Africa, revealed 10 typical cases of burns commonly seen in children and adults...
December 13, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29212452/the-effectiveness-of-physiologically-based-early-warning-or-track-and-trigger-systems-after-triage-in-adult-patients-presenting-to-emergency-departments-a-systematic-review
#6
Francesca Wuytack, Pauline Meskell, Aislinn Conway, Fiona McDaid, Nancy Santesso, Fergal G Hickey, Paddy Gillespie, Adam J N Raymakers, Valerie Smith, Declan Devane
BACKGROUND: Changes to physiological parameters precede deterioration of ill patients. Early warning and track and trigger systems (TTS) use routine physiological measurements with pre-specified thresholds to identify deteriorating patients and trigger appropriate and timely escalation of care. Patients presenting to the emergency department (ED) are undiagnosed, undifferentiated and of varying acuity, yet the effectiveness and cost-effectiveness of using early warning systems and TTS in this setting is unclear...
December 6, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29202698/safety-and-applicability-of-a-pre-stage-public-access-ventilator-for-trained-laypersons-a-proof-of-principle-study
#7
Patricia Fuchs, Juliane Obermeier, Svend Kamysek, Martin Degner, Hannes Nierath, Henning Jürß, Hartmut Ewald, Jens Schwarz, Martin Becker, Jochen K Schubert
BACKGROUND: Contemporary resuscitation guidelines for basic life support recommend an immediate onset of cardiac compressions in case of cardiac arrest followed by rescue breaths. Effective ventilation is often omitted due to fear of doing harm and fear of infectious diseases. In order to improve ventilation a pre-stage of an automatic respirator was developed for use by laypersons. METHODS: Fifty-two healthy volunteers were ventilated by means of a prototype respirator via a full-face mask in a pilot study...
December 4, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29191159/barriers-and-facilitating-factors-related-to-use-of-early-warning-score-among-acute-care-nurses-a-qualitative-study
#8
John Asger Petersen, Lars S Rasmussen, Susan Rydahl-Hansen
BACKGROUND: The early warning score (EWS) was developed to identify deteriorating patients early. It is a track-and-trigger system based on vital signs designed to direct appropriate clinical responses based on the seriousness and nature of the underlying condition. Despite its wide dissemination, serious adverse events still occur, often due to failure among staff on general wards to follow the EWS protocol. The purpose of the study was to determine barriers and facilitating factors related to three aspects of the EWS protocol: 1) adherence to monitoring frequency, 2) call for junior doctors to patients with an elevated EWS, and 3) call for the medical emergency team...
December 1, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29183276/the-effectiveness-of-prehospital-hypertonic-saline-for-hypotensive-trauma-patients-a-systematic-review-and-meta-analysis
#9
I E Blanchard, A Ahmad, K L Tang, P E Ronksley, D Lorenzetti, G Lazarenko, E S Lang, C J Doig, H T Stelfox
BACKGROUND: The optimal prehospital fluid for the treatment of hypotension is unknown. Hypertonic fluids may increase circulatory volume and mute the pro-inflammatory response of the body to injury and illness. The purpose of this systematic review is to determine whether in patients presenting with hypotension in the prehospital setting (population), the administration of hypertonic saline (intervention), compared to an isotonic fluid (control), improves survival to hospital discharge (outcome)...
November 28, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29121883/the-association-of-duration-of-boarding-in-the-emergency-room-and-the-outcome-of-patients-admitted-to-the-intensive-care-unit
#10
Saad Al-Qahtani, Abdullah Alsultan, Samir Haddad, Abdulmohsen Alsaawi, Moeed Alshehri, Sami Alsolamy, Afef Felebaman, Hani M Tamim, Nawfal Aljerian, Abdulaziz Al-Dawood, Yaseen Arabi
BACKGROUND: The demand for critical care beds is increasing out of proportion to bed availability. As a result, some critically ill patients are kept in the Emergency Department (ED boarding) awaiting bed availability. The aim of our study is to examine the impact of boarding in the ED on the outcome of patients admitted to the Intensive Care Unit(ICU). METHODS: This was a retrospective analysis of ICU data collected prospectively at King Abdulaziz Medical City, Riyadh from ED between January 2010 and December 2012 and all patients admitted during this time were evaluated for their duration of boarding...
November 9, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29110718/cardiac-patients-perceptions-of-neighboring-patients-risk-influence-on-psychological-stress-in-the-ed-and-subsequent-posttraumatic-stress
#11
Beatrice Konrad, David Hiti, Bernard P Chang, Jessica Retuerto, Jacob Julian, Donald Edmondson
BACKGROUND: As many as 12% of acute coronary syndrome (ACS) patients screen positive for post-traumatic stress disorder (PTSD) symptoms due to their cardiac event, and emergency department (ED) factors such as overcrowding have been associated with risk for PTSD. We tested the association of patients' perceptions of their proximity to a critically ill patient during ED evaluation for ACS with development of posttraumatic stress symptoms (PSS) in the month after hospital discharge. METHODS: Participants were enrolled in the REactions to Acute Care and Hospitalization (REACH) study during evaluation for ACS in an urban ED...
November 6, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29096608/who-breaches-the-four-hour-emergency-department-wait-time-target-a-retrospective-analysis-of-374-000-emergency-department-attendances-between-2008-and-2013-at-a-type-1-emergency-department-in-england
#12
Niklas Bobrovitz, Daniel S Lasserson, Adam D M Briggs
BACKGROUND: The four-hour target is a key hospital emergency department performance indicator in England and one that drives the physical and organisational design of the ED. Some studies have identified time of presentation as a key factor affecting waiting times. Few studies have investigated other determinants of breaching the four-hour target. Therefore, our objective was to describe patterns of emergency department breaches of the four-hour wait time target and identify patients at highest risk of breaching...
November 2, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29037168/locating-helicopter-emergency-medical-service-bases-to-optimise-population-coverage-versus-average-response-time
#13
Alan A Garner, Pieter L van den Berg
BACKGROUND: New South Wales (NSW), Australia has a network of multirole retrieval physician staffed helicopter emergency medical services (HEMS) with seven bases servicing a jurisdiction with population concentrated along the eastern seaboard. The aim of this study was to estimate optimal HEMS base locations within NSW using advanced mathematical modelling techniques. METHODS: We used high resolution census population data for NSW from 2011 which divides the state into areas containing 200-800 people...
October 16, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29029604/trauma-burden-in-tanzania-a-one-day-survey-of-all-district-and-regional-public-hospitals
#14
Hendry R Sawe, Juma A Mfinanga, Khalid R Mbaya, Phillip M Koka, Said S Kilindimo, Michael S Runyon, Victor G Mwafongo, Lee A Wallis, Teri A Reynolds
BACKGROUND: Trauma contributes significantly to the burden of disease and mortality throughout the world, but particularly in developing countries. In Tanzania, there is an enormous research gap on trauma; the limited data available reflects realities in cities and areas with moderately- to highly-resourced treatment centers. Our aim was to provide a description of the injury epidemiology across all of Tanzania. Our data will serve as a basis for future larger studies. METHODS: This is a subgroup analysis of a cross-sectional, prospective study of the clinical epidemiology of patients presenting at all public district and regional hospitals in Tanzania...
October 13, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28974202/weaknesses-and-capacities-affecting-the-prehospital-emergency-care-for-victims-of-road-traffic-incidents-in-the-greater-kampala-metropolitan-area-a-cross-sectional-study
#15
Joseph Kimuli Balikuddembe, Ali Ardalan, Davoud Khorasani-Zavareh, Amir Nejati, Owais Raza
BACKGROUND: Pre-hospital emergency care is a vital and integral component of health systems particularly in the resource constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities and trauma caused by the road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA). METHODS: A cross-sectional study was conducted in the GKMA using a three-part structured questionnaire...
October 3, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28854879/identifying-priorities-for-quality-improvement-at-an-emergency-department-in-ghana
#16
Annelies DeWulf, Elom H Otchi, Sari Soghoian
BACKGROUND: Healthcare quality improvement (QI) is a global priority, and understanding the perspectives of frontline healthcare workers can help guide sustainable and meaningful change. We report a qualitative investigation of emergency department (ED) staff priorities for QI at a tertiary care hospital in Ghana. The aims of the study were to educate staff about the World Health Organization's (WHO) definition of quality in healthcare, and to identify an initial focus for building a departmental QI program...
August 30, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28854874/recognition-and-treatment-of-severe-sepsis-in-the-emergency-department-retrospective-study-in-two-french-teaching-hospitals
#17
Philippe Le Conte, Séverin Thibergien, Jean Batiste Obellianne, Emmanuel Montassier, Gilles Potel, Pierre Marie Roy, Eric Batard
BACKGROUND: Sepsis management in the Emergency Department remains a daily challenge. The Surviving Sepsis Campaign (SSC) has released three-hour bundle. The implementation of these bundles in European Emergency Departments remains poorly described. The main objective was to assess the compliance with the Severe Sepsis Campaign 3-h bundle (blood culture, lactate dosage, first dose of antibiotics and 30 ml/kg fluid challenge). Secondary objectives were the analysis of the delay of severe sepsis recognition and description of the population...
August 30, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28851296/design-and-rationale-of-the-procalcitonin-antibiotic-consensus-trial-proact-a-multicenter-randomized-trial-of-procalcitonin-antibiotic-guidance-in-lower-respiratory-tract-infection
#18
David T Huang, Derek C Angus, Chung-Chou H Chang, Yohei Doi, Michael J Fine, John A Kellum, Octavia M Peck-Palmer, Francis Pike, Lisa A Weissfeld, Jonathan Yabes, Donald M Yealy
BACKGROUND: Overuse of antibiotics is a major public health problem, contributing to growing antibiotic resistance. Procalcitonin has been reported to be commonly elevated in bacterial, but not viral infection. Multiple European trials found procalcitonin-guided care reduced antibiotic use in lower respiratory tract infection, with no apparent harm. However, applicability to US practice is limited due to trial design features impractical in the US, between-country differences, and residual safety concerns...
August 29, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28851280/post-traumatic-stress-disorder-and-its-predictors-in-emergency-medical-service-personnel-a-cross-sectional-study-from-karachi-pakistan
#19
Salima Mansoor Kerai, Uzma Rahim Khan, Muhammad Islam, Nargis Asad, Junaid Razzak, Omrana Pasha
BACKGROUND: Emergency medical service (EMS) personnel who work to provide emergency medical care at the scene and during transportation are exposed to various kinds of stressors and are particularly susceptible to developing stress-reactions. This study assesses symptoms of post-traumatic stress disorder and its predictors among the personnel of a selected EMS in Karachi, Pakistan. METHODS: Data were gathered from 518 personnel working in an EMS setting from February to May 2014...
August 29, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28743232/emergency-medical-service-provider-decision-making-in-out-of-hospital-cardiac-arrest-an-exploratory-study
#20
J Brandling, K Kirby, S Black, S Voss, J Benger
BACKGROUND: There are approximately 60,000 out-of-hospital cardiac arrests (OHCA) in the United Kingdom (UK) each year. Within the UK there are well-established clinical practice guidelines that define when resuscitation should be commenced in OHCA, and when resuscitation should cease. Background literature indicates that decision-making in the commencement and cessation of resuscitation efforts in OHCA is complex, and not comprehensively understood. No relevant research from the UK has been published to date and this research study seeks to explore the influences on UK Emergency Medical Service (EMS) provider decision-making when commencing and ceasing resuscitation attempts in OHCA...
July 25, 2017: BMC Emergency Medicine
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