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Ambulance Major Emergency

Douglas Steenblock
A 77-year-old woman who had been previously diagnosed with a major neurocognitive disorder became highly agitated and aggressive in a long-term care facility. She did not respond to intramuscular (IM) haloperidol plus lorazepam and had to be transported to the local emergency department (ED). In the ambulance, she remained highly agitated and was given 200 mg IM ketamine. Within minutes of receiving this, she de-escalated dramatically with no apparent adverse effects and remained stable for several days. Although ketamine has been used recently in pre-hospital settings and EDs to reduce agitated behavior, there has been little if any investigation of its potential for reducing behavior disturbances in patients who suffer from major neurocognitive disorders...
February 26, 2018: American Journal of Geriatric Psychiatry
Win Sen Kuan, Simon Craig, Anne-Maree Kelly, Gerben Keijzers, Sharon Klim, Colin A Graham, Peter Jones, Anna Holdgate, Charles Lawoko, Said Laribi
INTRODUCTION: Shortness of breath is a common presenting symptom to the emergency department (ED) that can arise from a myriad of possible diagnoses. Asthma is one of the major causes. OBJECTIVE: To describe the demographic features, clinical characteristics, management and outcomes of adults with an emergency department (ED) diagnosis of asthma who presented to an ED in the Asia Pacific region with a principal symptom of dyspnea. METHODS: Planned sub-study of patients with an ED diagnosis of asthma identified in the Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM) study...
February 22, 2018: Clinical Respiratory Journal
Michael B Mwandri, Timothy C Hardcastle
BACKGROUND: Botswana is notable among countries with high rates of Road Traffic Collisions (RTC); like many other lower-middle-income countries (LMICs), it lacks trauma systems. The World Health Organization recommends 'Essential Trauma Care' in countries with no formal trauma systems. The proportion of injuries in Emergency Departments and the care process were investigated to gain an overview for enabling the design of a relevant LMICs trauma system. METHOD: Blunt and penetrating trauma patients were included from three major hospitals, examining the proportion of injuries, patient characteristics, the care process and comparing these between pediatrics and adults...
February 15, 2018: World Journal of Surgery
Feras Abuzeyad, Leena Alqasem, Mudhaffar I Al Farras, Shaikha S Al Jawder, Ghada Al Qasim, Salah Alghanem
It has been more than a decade since emergency medicine became recognized as a specialty in the Kingdom of Bahrain. In the last fifteen years emergency medicine has widely established itself and developed rapidly in the Kingdom. The three main emergency departments are: Salmanyia Medical Complex (SMC), Royal Medical Services of Bahrain Defence Force (RMS-BDF) and King Hamad University Hospital (KHUH) are now fully equipped and operated by a majority of board certified emergency physicians.Standardized protocols, and the Central National Ambulance will be established in the near future, and the ambulances will offer both basic and advanced life support by trained nurses and paramedics...
February 8, 2018: International Journal of Emergency Medicine
S Wilk, L Siegl, K Siegl, C Hohenstein
BACKGROUND: In an analysis of a critical incident reporting system (CIRS) in out-of-hospital emergency medicine, it was demonstrated that in 30% of cases deficient communication led to a threat to patients; however, the analysis did not show what exactly the most dangerous work processes are. Current research shows the impact of poor communication on patient safety. OBJECTIVES: An out-of-hospital workflow analysis collects data about key work processes and risk areas...
February 5, 2018: Der Anaesthesist
Takwa Tlili, Sofiene Abidi, Saoussen Krichen
This work focuses on a real-life patient transportation problem derived from emergency medical services (EMS), whereby providing ambulatory service for emergency requests during disaster situations. Transportation of patients in congested traffic compounds already time sensitive treatment. An urgent situation is defined as individuals with major or minor injuries requiring EMS assistance simultaneously. Patients are either (1) slightly injured and treated on site or (2) are seriously injured and require transfer to points of care (PoCs)...
January 29, 2018: American Journal of Emergency Medicine
Sara W Nelson, Carl A Germann, Casey Z MacVane, Rebecca B Bloch, Timothy S Fallon, Tania D Strout
Introduction: Prior work links empathy and positive physician-patient relationships to improved healthcare outcomes. The objective of this study was to analyze a patient experience simulation for emergency medicine (EM) interns as a way to teach empathy and conscientious patient care. Methods: We conducted a qualitative descriptive study on an in situ, patient experience simulation held during EM residency orientation. Half the interns were patients brought into the emergency department (ED) by ambulance and half were family members...
January 2018: Western Journal of Emergency Medicine
Josh Seim, Melody J Glenn, Joshua English, Karl Sporer
BACKGROUND: Are 9-1-1 ambulances relatively late to poorer neighborhoods? Studies suggesting so often rely on weak measures of neighborhood (e.g., postal zip code), limit the analysis to particular ambulance encounters (e.g., cardiac arrest responses), and do little to account for variations in dispatch priority or intervention severity. METHODS: We merged EMS ambulance contact records in a single California county (n = 87,554) with tract-level data from the American Community Survey (n = 300)...
January 30, 2018: Prehospital Emergency Care
S Pekanoja, M Hoikka, H Kyngäs, S Elo
BACKGROUND: In Finland, approximately 40% of emergency medical service (EMS) missions do not result in transport of the patient to a hospital by ambulance, and there is wide variability in the reasons underlying non-transport decisions. The aim of this study was to describe the context of these EMS non-transport missions. METHODS: The data were collected retrospectively between 3 September and 20 October 2014 by investigating non-transport EMS charts (n = 1154)...
January 24, 2018: Acta Anaesthesiologica Scandinavica
Josephine Muhrbeck, Jonas Persson, Claes Hofman-Bang
OBJECTIVE: The use of pre-hospital ECGs (PH-ECG) reduces time to reperfusion for patients with ST-segment elevation myocardial infarction (STEMI). The feasibility of reperfusion therapy within 60 minutes for hospitals with 24/7 PCI capability has been questioned, and current guidelines have set time targets to 90 minutes. Our primary objective was to investigate the proportion of false-positive catheterization laboratory activations by PH-ECG. Our secondary objective was to describe the time intervals from first medical contact to reperfusion and to establish the proportion of patients receiving reperfusion within 60 minutes...
January 23, 2018: Scandinavian Cardiovascular Journal: SCJ
Anriada Nassif, Daniel G Ostermayer, Kim B Hoang, Mary K Claiborne, Elizabeth A Camp, Manish I Shah
BACKGROUND: Respiratory distress due to asthma is a common reason for pediatric emergency medical services (EMS) transports. Timely initiation of asthma treatment, including glucocorticoids, improves hospital outcomes. The impact of EMS-administered glucocorticoids on hospital-based outcomes for pediatric asthma patients is unknown. OBJECTIVE: The objective of this study was to evaluate the effect of an evidence-based pediatric EMS asthma protocol update, inclusive of oral glucocorticoid administration, on time to hospital discharge...
January 19, 2018: Prehospital Emergency Care
Alberto Barbieri, Gabriele Melegari, Valentina Lob, Lorenzo Mazzali, Luca D'Amelio, Andrea Giovannoni, Enrico Giuliani
INTRODUCTION: The objectives of this study were to compare prevalence rates of different pathologies, ambulance system and emergency department management times, and patient survival and hazard ratios for codes 2 and 3 in two hub hospitals in Modena in the 36-month period across the stages of two major earthquakes in short sequence in Northern Italy in 2012. METHODS: Clinical records pertaining to the emergency care of patients were analyzed and only those assigned status codes 2 and 3 by ambulance professionals were included (if the assessment was confirmed by emergency department triage)...
January 18, 2018: Prehospital Emergency Care
Lynn M Sibley, Yared Amare, Solomon Tesfaye Abebe, Mulusew Lijalem Belew, Kemeredin Shiffra, Danika Barry
BACKGROUND: In 2014, USAID and University Research Co., LLC, initiated a new project under the broader Translating Research into Action portfolio of projects. This new project was entitled Systematic Documentation of Illness Recognition and Appropriate Care Seeking for Maternal and Newborn Complications. This project used a common protocol involving descriptive mixed-methods case studies of community projects in six low- and middle-income countries, including Ethiopia. In this paper, we present the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) case study...
December 21, 2017: Journal of Health, Population, and Nutrition
David R Vinson, Dustin W Ballard, Jie Huang, Mary E Reed, James S Lin, Mamata V Kene, Dana R Sax, Adina S Rauchwerger, David H Wang, D Ian McLachlan, Tamara S Pleshakov, Matthew A Silver, Victoria A Clague, Andrew S Klonecke, Dustin G Mark
STUDY OBJECTIVE: Outpatient management of emergency department (ED) patients with acute pulmonary embolism is uncommon. We seek to evaluate the facility-level variation of outpatient pulmonary embolism management and to describe patient characteristics and outcomes associated with home discharge. METHODS: The Management of Acute Pulmonary Embolism (MAPLE) study is a retrospective cohort study of patients with acute pulmonary embolism undertaken in 21 community EDs from January 2013 to April 2015...
December 13, 2017: Annals of Emergency Medicine
Ian Pope, Sharif Ismail, David McCoy, Tim Harris
OBJECTIVE: To investigate factors associated with unscheduled admission following presentation to Emergency Departments (EDs) at three hospitals in England. DESIGN AND SETTING: Cross-sectional analysis of attendance data for patients from three urban EDs in England: a large teaching hospital and major trauma centre (Site 1), and two district general hospitals (Sites 2 and 3). Variables included: patient age, gender, ethnicity, deprivation score, arrival date and time, arrival by ambulance or otherwise, a variety of ED workload measures, inpatient bed occupancy rates and admission outcome...
December 2017: Emergency Medicine Journal: EMJ
Stefan Heschl, Emily Andrew, Anthony de Wit, Stephen Bernard, Marcus Kennedy, Karen Smith
OBJECTIVE: The optimal volume and type of intravenous fluid for the treatment of blood loss in the prehospital setting is controversial. The use of red cell concentrates (RCCs) may be associated with improved outcomes; however, the administration of blood products is limited to physicians in many jurisdictions. We sought to describe the characteristics of RCC transfusions in a paramedic-staffed helicopter emergency medical system in Victoria, Australia. METHODS: We performed a retrospective analysis of all cases where paramedics consulted the responsible physician for approval of RCC transfusion between July 2011 and December 2015 in Victoria, Australia...
November 17, 2017: Emergency Medicine Australasia: EMA
Puneet Misra, Anindo Majumdar, Mahesh Chandra Misra, Shashi Kant, Sanjeev Kumar Gupta, Amit Gupta, Subodh Kumar
Background and Aims: There is paucity of data regarding some of the lesser known contextual and epidemiological factors with respect to road traffic injuries (RTIs). The objective was to study the epidemiological profile of RTI victims attending an emergency department of a tertiary care trauma center. Methods: The present study was a hospital-based cross-sectional study conducted in the emergency department of a tertiary care trauma center in New Delhi. All patients of RTI attending the emergency department during the designated data collection days were included in the study...
October 2017: Indian Journal of Critical Care Medicine
Leigh Curtis, Mark Salmon, Richard M Lyon
OBJECTIVE: This study sought to assess the impact of a helicopter emergency medical service (HEMS) capable of night operations. METHODS: This is a retrospective case review of all night HEMS missions attended by a charity air ambulance service in South East England over a 2-year period (October 1, 2013, to October 1, 2015). RESULTS: During the 2-year trial period, the HEMS service undertook a total of 5,004 missions and attended to 3,728 patients...
November 2017: Air Medical Journal
Yoshikazu Takinami, Shinji Maeda
Aim: To determine the characteristics and trends of medical emergencies during school activities by analyzing information provided by fire departments. Methods: During a 5-year period from January 2009 to December 2013, all nine fire departments in Fukui Prefecture handled 850 emergencies at schools. We investigated the 850 cases with the age range of 0-63 years. Results: It was found that 21.5% of ambulance dispatches to schools were on weekends and there were more dispatches for non-faculty members of all age groups on weekends than on weekdays...
January 2017: Acute Medicine & Surgery
Godwin O Akaba, Bissallah A Ekele
Our study sought to determine the maternal and fetal outcomes of emergency obstetric referrals to a Nigerian teaching hospital as well as assess reasons for these referrals. We enrolled women referred or who presented themselves to the emergency obstetric unit for management of complications of pregnancy, labour, delivery or the puerperium. The majority presented late, their mean duration of stay at the referring facility being 22.25 h. Only nine (7.3%) were transported by ambulance. Severe pre-eclampsia and eclampsia (in 33, 26...
January 1, 2017: Tropical Doctor
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