BMC Emergency Medicine via MedWorm.com

Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

BMC Emergency Medicine — Wed, 04 Jan 2012 05:00:00 +0100

Conclusions: The present ABCDE-triage system combined with public guidance may reduce patient visits to primary health care EDs but not to the secondary health care EDs. Limiting the access of less urgent patients to ED may redirect the demands of patients to private sector rather than office hours GP services. (Source: BMC Emergency Medicine)

Factors influencing injury severity score regarding Thai military personnel injured in mass casualty incident April 10, 2010: Lessons learned from armed conflict casualties: a retrospective study

BMC Emergency Medicine — Tue, 03 Jan 2012 05:00:00 +0100

Background: Political conflicts in Bangkok, Thailand have caused mass casualties, especially the latest event April 10, 2010, in which many military personnel were injured. Most of them were transferred to Phramongkutklao Hospital, the largest military hospital in Thailand. The current study aimed to assess factors influencing Injury Severity Score (ISS) regarding Thai military personnel injured in the mass casualty incident (MCI) April 10, 2010. Methods: A total of 728 injured soldiers transferred to Phramongkutklao Hospital were reviewed. Descriptive statistics was used to display characteristics of the injuries, relationship between mechanism of injury and injured body regions. Multiple logistic regressions were used to calculate the adjusted odds ratio (adjusted OR) of ISS comparing in...

Characteristics of frequent emergency department presenters to an Australian emergency medicine network.

BMC Emergency Medicine — Fri, 16 Dec 2011 05:00:00 +0100

Conclusions: There are major implications for the utilisation of limited ED resources by frequent presenters. By further understanding the characteristics of FP we may be able to address the specific health care needs of this population in more efficient and cost effective ways. Further research analysing the effectiveness of targeted multidisciplinary interventions aiming to reduce the frequency of ED attendances may be warranted. (Source: BMC Emergency Medicine)

Impact of physical fitness and biometric data on the quality of external chest compression: a randomised, crossover trial

BMC Emergency Medicine — Fri, 04 Nov 2011 04:00:00 +0100

Assessment of BMI and physical fitness, particularly focusing on the upper body, can predict quality of external chest compressions, with rescuers with higher BMI and greater physical fitness performing better quality external chest compressions and experiencing less fatigue. (Source: BMC Emergency Medicine)

Be careful with triage in emergency departments: interobserver agreement on 1,578 patients in France

BMC Emergency Medicine — Mon, 31 Oct 2011 04:00:00 +0100

Conclusions: The lack of physician-nurse agreement and the inability to predict hospitalization have important implications for patient safety. When urgency screening is used to determine treatment priority, disagreement might not matter because all patients in the ED are seen and treated. But using assessments as the basis for refusal of care to potential nonurgent patients raises legal, ethical, and safety issues. Managed care organizations should be cautious when applying such criteria to restrict access to EDs. (Source: BMC Emergency Medicine)

Injury in China: a systematic review of injury surveillance studies conducted in Chinese hospital emergency departments

BMC Emergency Medicine — Wed, 26 Oct 2011 04:00:00 +0100

Conclusion: Despite the limited number of studies identified, the scope of each highlights the willingness and the capacity to conduct surveillance studies in the emergency department. This Review highlights the need for the adoption of standardized injury coding indices in the collection and reporting of patient health data. While high level injury surveillance systems focus on population-based priority setting, this Review demonstrates the need to establish an internationally comparable trauma registry that would permit monitoring of the trauma system and would by extension facilitate the optimal care of the injured patient through the development of informed quality assurance programs and the implementation of evidence-based health policy. (Source: BMC Emergency Medicine)

Design of the RINSE Trial: The Rapid Infusion of cold Normal Saline by paramedics during CPR

BMC Emergency Medicine — Thu, 13 Oct 2011 04:00:00 +0100

This study aims to determine whether paramedic cooling during CPR improves outcome compared standard treatment in patients who are being resuscitated from out-of-hospital cardiac arrest.Methods/DesignThis paper describes the methodology for a definitive multi-centre, randomised, controlled trial of paramedic cooling during CPR compared with standard treatment. Paramedic cooling during CPR will be achieved using a rapid infusion of large volume (20-40 mL/kg to a maximum of 2 litres) ice-cold (4°C) normal saline.The primary outcome measure is survival at hospital discharge. Secondary outcome measures are rates of return of spontaneous circulation, rate of survival to hospital admission, temperature on arrival at hospital, and 12 month quality of life of survivors.DiscussionThis trial will t...

Design of the RINSE Trial: The Rapid Infusion of Cold Normal Saline by Paramedics during CPR.

BMC Emergency Medicine — Thu, 13 Oct 2011 04:00:00 +0100

This study aims to determine whether paramedic cooling during CPR improves outcome compared standard treatment in patients who are being resuscitated from out-of-hospital cardiac arrest.Methods / DesignThis paper describes the methodology for a definitive multi-centre, randomised, controlled trial of paramedic cooling during CPR compared with standard treatment. Paramedic cooling during CPR will be achieved using a rapid infusion of large volume (20-40mL/kg to a maximum of 2 litres) ice-cold (4 degrees Celcius) normal saline. The primary outcome measure is survival at hospital discharge. Secondary outcome measures are rates of return of spontaneous circulation, rate of survival to hospital admission, temperature on arrival at hospital, and 12 month quality of life of survivors.DiscussionTh...

Emergency Department Triage: an Ethical Analysis

BMC Emergency Medicine — Fri, 07 Oct 2011 04:00:00 +0100

This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights.SummaryWe integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective...

Methodology for the Development of a Canadian National EMS Research Agenda

BMC Emergency Medicine — Fri, 30 Sep 2011 04:00:00 +0100

The objective of this project is to develop a national EMS research agenda for Canada that will: 1) explore what barriers to EMS research currently exist, 2) identify current strengths and opportunities that may be of benefit to advancing EMS research, 3) make recommendations to overcome barriers and capitalize on opportunities, and 4) identify national EMS research priorities. Methods: Paramedics, educators, EMS managers, medical directors, researchers and other key stakeholders from across Canada will be purposefully recruited to participate in this mixed methods study, which consists of three phases: 1) qualitative interviews with a selection of the study participants, who will be asked about their experience and opinions about the four study objectives, 2) a facilitated roundtable disc...

Using Emergency Department-Based Inception Cohorts to Determine Genetic Characteristics Associated with Long Term Patient Outcomes after Motor Vehicle Collision: Methodology of the CRASH Study

BMC Emergency Medicine — Mon, 26 Sep 2011 04:00:00 +0100

DiscussionThe results from this study will provide insights into the pathophysiology of persistent pain and PTSD following MVC and may serve to improve the ability of clinicians and researchers to identify individuals at high risk for adverse outcomes following minor MVC. (Source: BMC Emergency Medicine)

Modeling Factors Influencing the Demand for Emergency Department Services in Ontario: A Comparison of Methods

BMC Emergency Medicine — Thu, 18 Aug 2011 23:00:00 +0100

Access to a primary care physician is an important predictor of emergency department (ED) utilization, suggesting that restructuring primary care services with aims of increasing access may result in reducing the numbers of less urgent ED visits. (Source: BMC Emergency Medicine)

Medical Student Professionalism Narratives: A Thematic Analysis and Interdisciplinary Comparative Investigation

BMC Emergency Medicine — Thu, 11 Aug 2011 23:00:00 +0100

${item.shortDescription} (Source: BMC Emergency Medicine)

Withholding and withdrawing life-sustaining therapy in a Moroccan Emergency Department: An observational study

BMC Emergency Medicine — Thu, 11 Aug 2011 23:00:00 +0100

${item.shortDescription} (Source: BMC Emergency Medicine)

Complete motor recovery after acute paraparesis caused by spontaneous spinal epidural hematoma: case report

BMC Emergency Medicine — Tue, 26 Jul 2011 23:00:00 +0100

${item.shortDescription} (Source: BMC Emergency Medicine)

Acute chest pain - A prospective population based study of contacts to Norwegian emergency medical communication centres

BMC Emergency Medicine — Wed, 20 Jul 2011 23:00:00 +0100

${item.shortDescription} (Source: BMC Emergency Medicine)

Role of Anesthesiology Curriculum in Improving Bag-mask Ventilation and Intubation Success Rates of Emergency Medicine Residents: A Prospective Descriptive Study

BMC Emergency Medicine — Wed, 15 Jun 2011 23:00:00 +0100

Conclusions: The success rate of emergency medicine residents in airway management improved significantly after completing anesthesiology rotation. Anesthesiology rotations should be considered as an essential component of emergency medicine training programs. A collateral curriculum of this nature should also focus on the acquisition of skills in airway management.Key words: Education, Curriculum, Anesthesiology, Emergency Medicine (Source: BMC Emergency Medicine)

ParaMED Home: A protocol for a randomised controlled trial of paramedic assessment and referral to access medical care at home

BMC Emergency Medicine — Tue, 07 Jun 2011 23:00:00 +0100

DiscussionIf this trial demonstrates clinical non-inferiority and cost savings associated with the primary assessment service, it will provide one means to safely address ED overcrowding.Trial RegistrationAustralian and New Zealand Clinical Trials Registry Number 12610001064099 (Source: BMC Emergency Medicine)

The Casualty Chain Inventory: A new Scale for Measuring Peritraumatic Responses: a cross-sectional study

BMC Emergency Medicine — Tue, 17 May 2011 23:00:00 +0100

Conclusions: The CCI appears to be a useful screening instrument for, at an early state, identifying patients hospitalized after a physical incident at risk for subsequent psychological distress. (Source: BMC Emergency Medicine)

Provider perceptions of barriers to the emergency use of tPA for Acute Ischemic Stroke: A qualitative study

BMC Emergency Medicine — Thu, 05 May 2011 23:00:00 +0100

Conclusions: Healthcare providers perceive environmental and patient-related factors as the primary barriers to adherence with acute stroke treatment guidelines. Interventions focused on increasing physician familiarity with and motivation to follow guidelines may be of highest yield in improving adherence. Improving self-efficacy in performing guideline concordant care may also be useful.Trial Registration: ClinicalTrials.gov identifier: NCT00349479 (Source: BMC Emergency Medicine)

Prehospital Evaluation and Economic Analysis of Different Coronary Syndrome Treatment Strategies - PREDICT - Rationale, Development and Implementation.

BMC Emergency Medicine — Mon, 28 Mar 2011 23:00:00 +0100

DiscussionWe anticipate four challenges to successful study implementation and have developed strategies for each: 1) diversity in the interpretation of the ethical and privacy issues across 47 research ethics boards/commiittees covering 71 hospitals, 2) remote oversight of data guardian abstraction, 3) timeliness of implementation, and 4) potential interference in the study by concurrent technological advances. Research ethics approvals from academic centres were obtained initially and submitted to non academic centre applications. Data guardians were trained by a single investigator and data entry is informed by a detailed data dictionary including variable definitions and abstraction instrucations and subjected to error and logic checks. Quality oversight provided by a single investigat...

Canadian Emergency Department Triage and Acuity Scale: implementation in a tertiary care center in Saudi Arabia

BMC Emergency Medicine — Thu, 10 Feb 2011 00:00:00 +0100

Conclusion: The CTAS may be adapted, with achievable objectives, in hospitals outside Canada as well. Time to see physician, total LOS, and LWBS are effective markers of ED performance and the quality of triage. Registration-to-physician time (RTP) and LOS profiles, stratified by triage level, are essential indicative markers for ED performance and should be used in improving patients flow through collaborative efforts. (Source: BMC Emergency Medicine)

Evaluation of the safety of C-spine clearance by paramedics: design and methodology

BMC Emergency Medicine — Tue, 01 Feb 2011 00:00:00 +0100

DiscussionApproximately 40% of all very low-risk trauma patients could be transported safely, without c-spine immobilization, if paramedics were empowered to make clinical decisions using the Canadian C-Spine Rule. This safety study is an essential step before allowing all paramedics across Canada to selectively immobilize trauma victims before transport. Once safety and potential impact are established, we intend to implement a multi-centre study to study actual impact.Trial Registration: ClinicalTrials.gov NCT01188447 (Source: BMC Emergency Medicine)

Barriers and facilitators to provide effective pre-hospital trauma care for road traffic injury victims in Iran: a grounded theory approach

BMC Emergency Medicine — Mon, 08 Nov 2010 00:00:00 +0100

Conclusions: Improving the interaction within the current pre-hospital trauma care system and building a common understanding of the role of the Emergency Medical Services (EMS) emerged as key issues in the development of an effective pre-hospital trauma care process. (Source: BMC Emergency Medicine)

OPTimizing IMaging in suspected APpendicitis (OPTIMAP-study): A multicenter diagnostic accuracy study of MRI in patients with suspected acute appendicitis. Study Protocol

BMC Emergency Medicine — Tue, 19 Oct 2010 23:00:00 +0100

DiscussionIf MRI is found to be sufficiently accurate, it could replace CT in some or all patients. This will limit or obviate the ionizing radiation exposure associated risk of cancer induction and contrast medium induced nephropathy with CT, preventing the burden and the direct and indirect costs associated with treatment. Based on the high intrinsic contrast resolution of MRI, one might envision higher accuracy rates for MRI than for CT. If so, MRI could further decrease the number of unnecessary appendectomies and the number of missed appendicitis cases.Trial registration: NTR2148 (Source: BMC Emergency Medicine)

Confusion after spine injury: cerebral fat embolism after traumatic rupture of a Tarlov cyst: Case report

BMC Emergency Medicine — Sat, 14 Aug 2010 23:00:00 +0100

Conclusions: Sacral perineurial cysts are rare, however they remain a potential cause of lumbosacral radiculopathy. (Source: BMC Emergency Medicine)

A concept for major incident triage: full-scaled simulation feasibility study

BMC Emergency Medicine — Tue, 10 Aug 2010 23:00:00 +0100

Background: Efficient management of major incidents involves triage, treatment and transport. In the absence of a standardised interdisciplinary major incident management approach, the Norwegian Air Ambulance Foundation developed Interdisciplinary Emergency Service Cooperation Course (TAS). The TAS-program was established in 1998 and by 2009, approximately 15 500 emergency service professionals have participated in one of more than 500 no-cost courses. The TAS-triage concept is based on the established triage Sieve and Paediatric Triage Tape models but modified with slap-wrap reflective triage tags and paediatric triage stretchers. We evaluated the feasibility and accuracy of the TAS-triage concept in full-scale simulated major incidents. Methods: The learners participated in two standardi...

The Impact of delays to admission from the emergency department on inpatient outcomes

BMC Emergency Medicine — Thu, 08 Jul 2010 23:00:00 +0100

Conclusions: Delays to admission from the ED are associated with increased IP LOS and IP cost. Improving patient flow through the ED may reduce hospital costs and improve quality of care. There may be a business case for investments to reduce emergency department admission delays. (Source: BMC Emergency Medicine)

Fructose-1, 6-diphosphate (FDP) as a novel antidote for yellow oleander-induced cardiac toxicity: A randomized controlled double blind study

BMC Emergency Medicine — Mon, 28 Jun 2010 23:00:00 +0100

DiscussionThis trial will provide information on the effectiveness of FDP in yellow oleander poisoning. If FDP is effective in cardiac glycoside toxicity, it would provide substantial benefit to the patients in rural Asia. The drug is inexpensive and thus could be made available at primary care hospitals if proven to be effective.Trial Registration: Current Controlled trials ISRCTN71018309 (Source: BMC Emergency Medicine)

The impact of a standardised intramuscular sedation protocol for acute behavioural disturbance in the emergency department

BMC Emergency Medicine — Sun, 27 Jun 2010 23:00:00 +0100

Conclusion The use of a standardised IM sedation protocol was simple, more effective and as safe for management of ABD compared to predominantly intravenous sedation. (Source: BMC Emergency Medicine)

Fatal poisonings in Oslo: a one-year observational study

BMC Emergency Medicine — Sat, 05 Jun 2010 23:00:00 +0100

Conclusions: Three per cent of all acute poisonings were fatal, and nine out of ten deaths by acute poisonings occurred outside hospital. Two-thirds were evaluated as accidental deaths. Although case fatality rates were highest for methanol, TCAs, and antihistamines, most deaths were caused by opiates or opioids. (Source: BMC Emergency Medicine)

Impact of the ABCDE triage on the number of patient visits to the emergency department

BMC Emergency Medicine — Wed, 02 Jun 2010 23:00:00 +0100

Conclusions: The present ABCDE-triage system combined with public guidance may reduce patient visits to primary health care EDs but not to the tertiary health care EDs. (Source: BMC Emergency Medicine)

Improving rigid fiberoptic intubation: a comparison of the Bonfils Intubating Fiberscope with a novel modification

BMC Emergency Medicine — Wed, 26 May 2010 23:00:00 +0100

Conclusions: With this data, we can infer that the novel fiberscope curvature appears to improve or maintain the quality of an intubation attempt (airway score, cricoid pressure requirement, intubation time, number of attempts, placement success). The data indicate that the novel fiberscope offers a superior intubation experience to currently available best practices. The instrument was well received and would be welcomed by most study participants should the device become clinically available in the future. (Source: BMC Emergency Medicine)

Treatment of hepatic encephalopathy by on-line hemodiafiltration: a case series study

BMC Emergency Medicine — Thu, 20 May 2010 23:00:00 +0100

Conclusions: On-line hemodiafiltration was effective in patients with acute liver failure, and consciousness was maintained for the duration of artificial liver support, even in those in whom it was considered that hepatic function was completely abolished. (Source: BMC Emergency Medicine)

The accuracy of pulse oximetry in emergency department patients with severe sepsis and septic shock: a retrospective cohort study

BMC Emergency Medicine — Tue, 04 May 2010 23:00:00 +0100

Background Pulse oximetry is routinely used to continuously and noninvasively monitor arterial oxygen saturation (SaO2) in critically ill patients. Although pulse oximeter oxygen saturation (SpO2) has been studied in several patient populations, including the critically ill, its accuracy has never been studied in emergency department (ED) patients with severe sepsis and septic shock. Sepsis results in characteristic microcirculatory derangements that could theoretically affect pulse oximeter accuracy. The purposes of the present study were twofold: 1) to determine the accuracy of pulse oximetry relative to SaO2 obtained from ABG in ED patients with severe sepsis and septic shock, and 2) to assess the impact of specific physiologic factors on this accuracy.Methods This analysis consisted of...

Towards the prevention of acute lung injury: a population based cohort study protocol

BMC Emergency Medicine — Mon, 26 Apr 2010 23:00:00 +0100

DiscussionThis population-based observational cohort study will identify patients at high risk early in the course of disease, the burden of ALI in the community, and the potential targets for future prevention trials. (Source: BMC Emergency Medicine)

Acute mercury poisoning: a case report

BMC Emergency Medicine — Fri, 19 Mar 2010 00:00:00 +0100

Conclusion: Public education on poisoning and the potential hazards of mercury are of vital importance for community health. (Source: BMC Emergency Medicine)

Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service

BMC Emergency Medicine — Mon, 08 Mar 2010 00:00:00 +0100

Conclusion: The Helicopter Emergency Medical Service of the eastern region of the Netherlands brings essential medical expertise in the field not provided by the emergency medical service. The Emergency Medical Service does not provide a significant quantity of procedures obviously needed by the paediatric patient. (Source: BMC Emergency Medicine)

Involvement in emergency situations by primary care doctors on-call in Norway - a prospective population-based observational study

BMC Emergency Medicine — Sat, 06 Mar 2010 00:00:00 +0100

Conclusion: Doctors on-call and GPs on daytime were involved in half of all red responses. There were large differences between the EMCCs in the frequency of doctors alerted. The inhabitants in the three EMMCs were thus offered different levels of professional competency in emergency situations outside hospitals. (Source: BMC Emergency Medicine)

Fatal accidental methanol ingestion

BMC Emergency Medicine — Mon, 22 Feb 2010 00:00:00 +0100

Conclusions: We conclude that in a hemodynamic instable situation high methanol concentrations and methanol-induced derangements of homeostasis are safely and effectively treated with CVVH-DF and that severe cerebral edema is another possible cause of death rather than the classical bleeding in the putamen area. (Source: BMC Emergency Medicine)

Support and Assessment for Fall Emergency Referrals (SAFER 1) trial protocol Full title: Computerised on-scene decision support for emergency ambulance staff to assess and plan care for older people who have fallen: evaluation of costs and benefits using a pragmatic cluster randomised trial

BMC Emergency Medicine — Tue, 26 Jan 2010 00:00:00 +0100

In conclusion, this complex emergency care trial will provide rigorous evidence on the clinical and cost effectiveness of CCDS for paramedics in the care of older people who have fallen.Trial Registration: ISRCTN10538608 (Source: BMC Emergency Medicine)

Respiratory sound energy and its distribution patterns following clinical improvement of congestive heart failure: a pilot study

BMC Emergency Medicine — Fri, 15 Jan 2010 00:00:00 +0100

Conclusions: With clinical improvement of acute CHF exacerbations, there was more homogenous distribution of lung vibration energy, as demonstrated by the increased geographical area of the vibration energy image. (Source: BMC Emergency Medicine)

Unique case of esophageal rupture after a fall from height

BMC Emergency Medicine — Tue, 15 Dec 2009 00:00:00 +0100

Conclusions: This case report presents a high cervical esophageal rupture without associated local injuries after a fall from height. (Source: BMC Emergency Medicine)

A cross-sectional study of Victorian mobile intensive care ambulance paramedics knowledge of the Valsalva manoeuvre

BMC Emergency Medicine — Mon, 14 Dec 2009 00:00:00 +0100

Conclusions: The formal education of Melbourne's MICA Paramedics would benefit from the introduction of an evidence based model of VM performance, which would impact positively on patient care and may improve reversion success in the prehospital setting.. The results of this study also demonstrate that an opportunity exists to promote the evidence-based VM criteria across the primary emergency care field. (Source: BMC Emergency Medicine)

Video conferencing versus telephone calls for team work across hospitals: a qualitative study on simulated emergencies

BMC Emergency Medicine — Mon, 30 Nov 2009 00:00:00 +0100

Conclusions: VC can improve clinical cooperation and decision processes in virtual teams during critical patient care. Such team interaction requires thoughtful organisation, training, and new rules for communication. (Source: BMC Emergency Medicine)

Evaluation of an algorithm for estimating a patient's life threat risk from an ambulance call

BMC Emergency Medicine — Tue, 20 Oct 2009 23:00:00 +0100

Conclusions: A patient's life threat risk was quantitatively assessed at the moment of the emergency call with a moderate level of accuracy. (Source: BMC Emergency Medicine)

Paramedic assessment of pain in the cognitively impaired adult patient

BMC Emergency Medicine — Mon, 05 Oct 2009 23:00:00 +0100

Conclusion: The reviews of pain assessment tools found that the majority were developed to assess chronic pain in aged care, hospital or hospice settings. An analysis of the characteristics of these pain assessment tools identified attributes that may limit their use in paramedic practice. One tool - the Abbey Pain Scale - may have application in paramedic assessment of pain, but clinical evaluation is required to validate this tool in the paramedic practice setting. Further research is recommended to evaluate the Abbey Pain Scale and to evaluate the effectiveness of paramedic pain management practice in older adults to ensure that the care of all patients is unaffected by age or disability. (Source: BMC Emergency Medicine)

Comparison of balance assessment modalities in emergency department elders: a pilot cross-sectional observational study

BMC Emergency Medicine — Sun, 27 Sep 2009 23:00:00 +0100

Conclusions: Over 40% of community-dwelling elder ED patients report a fall within the past year. Balance plate and TUG testing were feasibly conducted in an ED setting. There is no relationship between scores on balance plate and TUG testing in these patients. In regression analysis, neither modality was significantly associated with patient provided history of falls. These modalities should not be adopted for screening purposes in elders in the ED setting without validation in future studies or as part of multi-factorial risk assessment. (Source: BMC Emergency Medicine)

The intuitive use of laryngeal airway tools by first year medical students

BMC Emergency Medicine — Mon, 21 Sep 2009 23:00:00 +0100

Background: Providing a secured airway is of paramount importance in cardiopulmonary resuscitation. Although intubating the trachea is yet seen as gold standard, this technique is still reserved to experienced healthcare professionals. Compared to bag-valve facemask ventilation, however, the insertion of a laryngeal mask airway offers the opportunity to ventilate the patient effectively and can also be placed easily by lay responders. Obviously, it might be inserted without detailed background knowledge.The purpose of the study was to investigate the intuitive use of airway devices by first-year medical students as well as the effect of a simple, but well-directed training programme. Retention of skills was re-evaluated six months thereafter. Methods: The insertion of a LMA-Classic and a L...

Paramedic clinical decision making during high acuity emergency calls: design and methodology of a Delphi study

BMC Emergency Medicine — Sun, 20 Sep 2009 23:00:00 +0100

This study will utilize the Delphi technique to establish consensus on the most important instances of paramedic clinical decision making during high acuity emergency calls, as they relate to clinical outcome and patient safety. Methods: Participants in this multi-round survey study will be paramedic leaders and emergency medical services medical directors/physicians from across Canada. In the first round, participants will identify instances of clinical decision making they feel are important for patient outcome and safety. On the second round, the panel will rank each instance of clinical decision making in terms of its importance. On the third and potentially fourth round, participants will have the opportunity to revise the ranking they assigned to each instance of clinical decision ma...

The nature and causes of unintended events reported at ten emergency departments

BMC Emergency Medicine — Thu, 17 Sep 2009 23:00:00 +0100

Conclusions: Event reporting gives insight into diverse unintended events. The information on unintended events may help target research and interventions to increase patient safety. It seems worthwhile to direct interventions on the collaboration between the ED and other hospital departments. (Source: BMC Emergency Medicine)

Intracranial bleeding in patients with traumatic brain injury: A prognostic study

BMC Emergency Medicine — Sun, 02 Aug 2009 23:00:00 +0100

Conclusion: Large EDH, SDH and IPH are associated with a substantially higher probability of hospital mortality in comparison with small IB. However, the limitations of our data, such as the large proportion of missing data and lack of data on other confounding factors, such as localization of the bleeding, make the results of this report only explanatory. Future studies should also evaluate the effect of IB size on functional outcomes. (Source: BMC Emergency Medicine)

Intracranial bleeding in patients with traumatic brain injury: A prognostic study

BMC Emergency Medicine — Sun, 02 Aug 2009 23:00:00 +0100

Conclusions: Large EDH, SDH and IPH are associated with a substantially higher probability of hospital mortality in comparison with small IB. However, the limitations of our data, such as the large proportion of missing data and lack of data on other confounding factors, such as localization of the bleeding, make the results of this report only explanatory. Future studies should also evaluate the effect of IB size on functional outcomes. (Source: BMC Emergency Medicine)

A survey of factors associated with the successful recognition of agonal breathing and cardiac arrest by 9-1-1 call takers: design and methodology.

BMC Emergency Medicine — Thu, 30 Jul 2009 23:00:00 +0100

This study will be conducted in three phases using the Theory of Planned Behaviour. In Phase One, we will conduct semi-structured qualitative interviews with a purposeful selection of 9-1-1 call takers from Ontario, and identify common themes and belief categories. In Phase Two, we will use the qualitative interview results to design and pilot a quantitative survey. In Phase Three, a final version of the quantitative survey will be administered via an electronic medium to all registered call takers in the province of Ontario. We will perform qualitative thematic analysis (Phase One) and regression modelling (Phases Two and Three), to determine direct and indirect relationship of behavioural constructs with intentions to provide cardiopulmonary resuscitation instructions.DiscussionThe resul...

Crotaline Fab antivenom appears to be effective in cases of severe North American pit viper envenomation: An integrative review

BMC Emergency Medicine — Sun, 21 Jun 2009 23:00:00 +0100

Conclusions: In this structured literature review, FabAV appears to be effective in the management of severe crotaline snake envenomation. Incomplete response to therapy, recurrence of venom effects, and delayed-onset venom effects were reported in case reports, but not reported in cohort studies. (Source: BMC Emergency Medicine)

Negative predictive value and potential cost savings of acute nuclear myocardial perfusion imaging in low risk patients with suspected acute coronary syndrome: A prospective single blinded study

BMC Emergency Medicine — Thu, 18 Jun 2009 23:00:00 +0100

Conclusion: Our findings in a Swedish ED support the results of larger American trials that acute MPI has the potential to safely reduce the number of admissions and decrease overall costs for low-risk ED patients with suspected ACS. (Source: BMC Emergency Medicine)

The impact of a fast track area on quality and effectiveness outcomes: A Middle Eastern emergency department perspective

BMC Emergency Medicine — Tue, 16 Jun 2009 23:00:00 +0100

Background: Emergency department (ED) overcrowding is a ubiquitous problem with serious public health implications. The fast track area is a novel method which aims to reduce waiting time, patient dissatisfaction and morbidity. |The study objective was to determine the impact of a fast track area (FTA) on both effectiveness measures (i.e. waiting times [WT] and length of stay [LOS]) and quality measures (i.e. LWBS rates and mortality rates) in non-urgent patients. The secondary objective was to assess if a FTA negatively impacted on urgent patients entering the ED. Methods: The study took place in a 500 bed, urban, tertiary care hospital in Abu Dhabi, United Arab Emirates. This was a quasi-experimental, which examined the impact of a FTA on a pre-intervention control group (January 2005) (...

Case reports describing treatments in the emergency medicine literature: Misleading and missing information

BMC Emergency Medicine — Mon, 15 Jun 2009 04:00:00 +0100

Conclusions: Treatment-related CRs in emergency medicine journals often omit critical details about treatments, co-interventions, outcomes, generalizability, causality and denominators. As a result, the information may be misleading to providers, and the clinical applications may be detrimental to patient care. (Source: BMC Emergency Medicine)

Comparison of the Glidescope(R) and Pentax AWS(R) laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation.

BMC Emergency Medicine — Sun, 17 May 2009 04:00:00 +0100

Conclusion: The Glidescope(R) and AWS(R) devices possess advantages over the conventional Macintosh laryngoscope when used by Advanced Paramedics in normal and simulated difficult intubation scenarios in this manikin study. Further studies are required to extend these findings to the clinical setting. (Source: BMC Emergency Medicine)

Undergraduate medical education in emergency medical care: A nationwide survey at German medical schools

BMC Emergency Medicine — Tue, 12 May 2009 04:00:00 +0100

Conclusion: Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard level of education in emergency medical care. (Source: BMC Emergency Medicine)

Post-crash management of road traffic injury victims in Iran. Stakeholders' views on current barriers and potential facilitators

BMC Emergency Medicine — Tue, 12 May 2009 04:00:00 +0100

Conclusion: To sum up, it seems that the involvement of laypeople could be a key factor in making post-crash management more effective. But system improvements are also crucial, including the integration of the trauma system and its development in terms of human resources (staffing and training) and physical resources as well as the infrastructure development. (Source: BMC Emergency Medicine)

Modelling optimal location for pre-hospital helicopter emergency medical services

BMC Emergency Medicine — Sat, 09 May 2009 04:00:00 +0100

Conclusions: GIS based protocols for location of emergency medical resources can provide supportive evidence for allocation decisions - especially when resources are limited. In this study, we were able to demonstrate conclusively that a logical choice exists for location of additional HEMS. This protocol could be extended to location analysis for other emergency and health services. (Source: BMC Emergency Medicine)

Using molecular similarity to highlight the challenges of routine immunoassay-based drug of abuse/toxicology screening in emergency medicine

BMC Emergency Medicine — Tue, 28 Apr 2009 04:00:00 +0100

Conclusions: The expanding structural diversity of drugs presents a difficult challenge for routine DOA/Tox screening that limit the clinical utility of these tests in the emergency medicine setting. (Source: BMC Emergency Medicine)

Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation

BMC Emergency Medicine — Fri, 20 Feb 2009 05:00:00 +0100

Conclusions: Smaller self-inflating bags reduce the incidence of suboptimal tidal volumes and minute volumes and produce greater guideline consistent results for cardiac arrest patients. (Source: BMC Emergency Medicine)

Hands-on time during cardiopulmonary resuscitation is affected by the process of teambuilding: a prospective randomised simulator-based trial

BMC Emergency Medicine — Sat, 14 Feb 2009 05:00:00 +0100

Conclusions: Hands-on time and time to defibrillation, two performance markers of CPR with a proven relevance for medical outcome, are negatively affected by shortcomings in the process of ad-hoc team-building and particularly deficits in leadership. Team-building has thus to be regarded as an additional task imposed on teams forming ad-hoc during CPR. All physicians should be aware that early structuring of the own team is a prerequisite for timely and effective execution of CPR. (Source: BMC Emergency Medicine)

Comparison of the Airtraq(R) and Truview(R) laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation in manikins.

BMC Emergency Medicine — Fri, 13 Feb 2009 05:00:00 +0100

Conclusion: The Airtraq(R) laryngoscope performed more favourably than the Macintosh and Truview(R) devices when used by Paramedics in this manikin study. Further studies are required to extend these findings to the clinical setting. (Source: BMC Emergency Medicine)

Forecasting daily attendances at an emergency department to aid resource planning

BMC Emergency Medicine — Thu, 29 Jan 2009 05:00:00 +0100

Conclusions: Time series analysis has been shown to provide a useful, readily available tool for predicting emergency department workload that can be used to plan staff roster and resource planning. (Source: BMC Emergency Medicine)

Anion gap, anion gap corrected for albumin, base deficit and unmeasured anions in critically ill patients: implications on the assessment of metabolic acidosis and the diagnosis of hyperlactatemia

BMC Emergency Medicine — Tue, 16 Dec 2008 05:00:00 +0100

Conclusions: AG and BD failed to reliably detect the presence of clinically significant hyperlactatemia. Under idealized conditions, ACAG has the capacity to rule out the presence of hyperlactatemia. Lac levels should be obtained routinely in all patients admitted to the ICU in whom the possibility of shock/hypoperfusion is being considered. If an AG assessment is required in the ICU, it must be corrected for albumin for there to be sufficient diagnostic utility (Source: BMC Emergency Medicine)

The association of psychiatric comorbidity and use of the emergency department among persons with substance use disorders: an observational cohort study

BMC Emergency Medicine — Wed, 03 Dec 2008 05:00:00 +0100

Conclusions: The results provide further support for the notion that the ED could and should serve as an important identification site for cost-effective intervention. (Source: BMC Emergency Medicine)

Occupational stressors and its organizational and individual correlates: A nationwide study of Norwegian ambulance personnel

BMC Emergency Medicine — Tue, 02 Dec 2008 05:00:00 +0100

Conclusions: Ambulance-specific stressors were reported as both more severe and more frequently occurring stressors than were organizational stressors. Organizational working conditions were more strongly related to frequency of job stressors than were individual differences. In general, the relationship between occupational stressors and individual differences was weak. (Source: BMC Emergency Medicine)

Pre-hospital treatment of acute poisonings in Oslo

BMC Emergency Medicine — Mon, 24 Nov 2008 05:00:00 +0100

Conclusions: More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often caused by drug and alcohol abuse than in those who were hospitalized, and more than two-thirds were males. Almost half of those discharged from ambulances received an antidote. The pre-hospital treatment of these poisonings appears safe regarding short-term mortality. (Source: BMC Emergency Medicine)

Practical examination of bystanders performing Basic Life Support in Germany: a prospective manikin study

BMC Emergency Medicine — Thu, 20 Nov 2008 05:00:00 +0100

Background: In an out-of-hospital emergency situation bystander intervention is essential for a sufficient functioning of the chain of rescue. The basic measures of cardiopulmonary resuscitation (Basic Life Support - BLS) by lay people are therefore definitely part of an effective emergency service of a patient needing resuscitation. Relevant knowledge is provided to the public by various course conceptions. The learning success concerning a one day first aid course ("LSM" course in Germany) has not been much investigated in the past. We investigated to what extent lay people could perform BLS correctly in a standardized manikin scenario. An aim of this study was to show how course repetitions affected success in performing BLS. Methods: The "LSM course" was carried out in a standardized m...

Emergency department physician training in Jamaica: a national public hospital survey

BMC Emergency Medicine — Sun, 12 Oct 2008 04:00:00 +0100

Conclusions: The majority of medical officers in public hospital EDs across Jamaica are relatively inexperienced and inadequately trained. Consultant supervision is not available in most public hospital EDs. With the injury epidemic that exists in Jamaica, it is logical that increased training opportunities and resources are required to meet the needs of the population. (Source: BMC Emergency Medicine)

An evaluation of a Shockroom located CT scanner: a randomized study of early assessment by CT scanning in trauma patients in the bi-located trauma center North-West Netherlands (REACT trial)

BMC Emergency Medicine — Fri, 22 Aug 2008 04:00:00 +0100

DiscussionThe REACT-trial will provide evidence on the effects of a strategy involving early shockroom CT scanning compared with a standard diagnostic imaging strategy in trauma patients on both patient outcome and operations research.Trial registrationISRCTN55332315 (Source: BMC Emergency Medicine)

An evaluation of a Shockroom located CT scanner: a Randomized study of Early Assessment by CT scanning in Trauma patients in the bi-located Trauma center North-West Netherlands (REACT trial).

BMC Emergency Medicine — Fri, 22 Aug 2008 04:00:00 +0100

DiscussionThe REACT-trial will provide evidence on the effects of a strategy involving early shockroom CT scanning compared with a standard diagnostic imaging strategy in trauma patients on both patient outcome and operations research. Trial registration: ISRCTN55332315 (Source: BMC Emergency Medicine)

A review of patients who suddenly deteriorate in the presence of paramedics

BMC Emergency Medicine — Sat, 26 Jul 2008 04:00:00 +0100

Conclusions: This study suggests that the incidents of patients suddenly deteriorating in the presence of paramedics are low and the incidence of hospital bypass is not well documented. (Source: BMC Emergency Medicine)

Assessing emergency medical care in low income countries: a pilot study from Pakistan

BMC Emergency Medicine — Thu, 03 Jul 2008 04:00:00 +0100

Conclusions: Assessment of emergency care should be part of health systems analysis in Pakistan. Multiple deficiencies in emergency care at the district level in Pakistan were noted in our study. Priority should be given to make emergency care responsive to needs in Pakistan. Specific efforts should be directed to equip emergency care at district facilities and to organize an ambulance network. (Source: BMC Emergency Medicine)

The Current Crisis in Emergency Care and the Impact on Disaster Preparedness

BMC Emergency Medicine — Thu, 01 May 2008 04:00:00 +0100

DiscussionAfter 9/11, federal plans, procedures and benchmarks were mandated to assure a unified, comprehensive disaster response, ranging from local to federal activation of resources. Nevertheless, insufficient federal funding has contributed to a long-standing counter-trend which has eroded emergency medical care. The causes are complex and multifactorial, but they have converged to present a severely overburdened system that regularly exceeds emergency capacity and capabilities. This constant acute overcrowding, felt in communities all across the country, indicates a nation at risk. Federal funding has not sufficiently prioritized the improvements necessary for an emergency care infrastructure that is critical for an all hazards response to disaster and terrorist emergencies.SummaryCur...

Quality of care in elder emergency department patients with pneumonia: a prospective cohort study

BMC Emergency Medicine — Wed, 30 Apr 2008 04:00:00 +0100

Conclusions: Elderly patients admitted from the ED with pneumonia are more likely to receive antibiotics while in the ED and to have oxygenation assessed in the ED than younger patients. The independent association of certain patient characteristics with process failure provides an opportunity to further increase compliance with recommended quality measures in admitted patients diagnosed with pneumonia. (Source: BMC Emergency Medicine)

An Evaluation of the Osmole Gap as a Screening Test for Toxic Alcohol Poisoning

BMC Emergency Medicine — Mon, 28 Apr 2008 04:00:00 +0100

Conclusions: In this sample, an osmole gap threshold of 10 has a sensitivity and negative predictive value of 1 for identifying patients for whom hemodialysis is recommended, independent of the ethanol coefficient applied. In patients potentially requiring antidotal therapy, applying an ethanol coefficient of 1.25 resulted in a higher specificity and positive predictive value without compromising the sensitivity. (Source: BMC Emergency Medicine)

Influence of airway management strategy on No-Flow-Time during an Advanced Life Support Course for intensive care nurses - a single rescuer resuscitation manikin study

BMC Emergency Medicine — Thu, 10 Apr 2008 04:00:00 +0100

Background: In 1999, the laryngeal tube (VBM Medizintechnik, Sulz, Germany) was introduced as a new supraglottic airway. It was designed to allow either spontaneous breathing or controlled ventilation during anaesthesia; additionally it may serve as an alternative to endotracheal intubation, or bag-mask ventilation during resuscitation. Several variations of this supraglottic airway exist. In our study, we compared ventilation with the laryngeal tube suction for single use (LTS-D) and a bag-mask device. One of the main points of the revised ERC 2005 guidelines is a low no-flow-time (NFT). The NFT is defined as the time during which no chest compression occurs. Traditionally during the first few minutes of resuscitation NFT is very high. We evaluated the hypothesis that utilization of the L...

A study to derive a clinical decision rule for triage of emergency department patients with chest pain: design and methodology

BMC Emergency Medicine — Wed, 06 Feb 2008 05:00:00 +0100

DiscussionThe study will derive a highly sensitive clinical decision rule to identify low risk patients safe for early discharge. This will improve patient care, lower healthcare costs, and enhance flow in our busy and overcrowded emergency departments. (Source: BMC Emergency Medicine)

Thematic Research network for emergency and UnScheduled Treatment (TRUST): scoping the potential

BMC Emergency Medicine — Wed, 30 Jan 2008 05:00:00 +0100

Conclusions: The study included views from patient, provider, policy and academic perspectives and built the case for a research network in emergency care. Now funded, TRUST (Thematic Research network for emergency and UnScheduled Treatment) will allow the development of research proposals, building of research teams and recruitment of sites and patients both in Wales and across the UK. It aims to address the imbalance between investment and research in this area and help support provision of 'the right care to the right people at the right time'. (Source: BMC Emergency Medicine)

Systematic review of randomized clinical trials on the use of hydroxyethyl starch for fluid management in sepsis

BMC Emergency Medicine — Thu, 24 Jan 2008 05:00:00 +0100

Conclusions: Hydroxyethyl starch increases the risk of acute renal failure among patients with sepsis and may also reduce the probability of survival. While the evidence reviewed cannot necessarily be applied to other clinical indications, hydroxyethyl starch should be avoided in sepsis. (Source: BMC Emergency Medicine)

Preparedness of emergency departments in north west England for managing chemical incidents: a structured interview survey

BMC Emergency Medicine — Thu, 20 Dec 2007 05:00:00 +0100

Conclusions: We have identified major inconsistencies in the preparedness of North West Emergency Departments for managing chemical incidents. Nationally recognized standards on incident planning, facilities, equipment and procedures need to be agreed and implemented with adequate resources. Issues of environmental safety and patient dignity and comfort should also be addressed. (Source: BMC Emergency Medicine)

Prevalence and demographics of methicillin resistant staphylococcus aureus in culturable skin and soft tissue infections in an urban emergency department

BMC Emergency Medicine — Wed, 31 Oct 2007 04:00:00 +0100

Conclusion: In this population of emergency department patients, MRSA skin infection was related to youth, recent sexual contact, presence of abscess, low body mass index, spontaneity of infection, incarceration or contact with an inmate, and group home living. (Source: BMC Emergency Medicine)

Cost-efficiency assessment of Advanced Life Support (ALS) courses based on the comparison of advanced simulators with conventional manikins

BMC Emergency Medicine — Mon, 22 Oct 2007 04:00:00 +0100

Background: Simulation is an essential tool in modern medical education. The object of this study was to assess, in cost-effective measures, the introduction of new generation simulators in an adult life support (ALS) education program. Methods: Two hundred fifty primary care physicians and nurses were admitted to ten ALS courses (25 students per course). Students were distributed at random in two groups (125 each). Group A candidates were trained and tested with standard ALS manikins and Group B ones with new generation emergency and life support integrated simulator systems. Results: In group A, 98 (78%) candidates passed the course, compared with 110 (88%) in group B (p < 0.01). The total cost of conventional courses was E 7689 per course and the cost of the advanced simulator courses...

Prehospital score for acute disease: a community-based observational study in Japan

BMC Emergency Medicine — Mon, 15 Oct 2007 04:00:00 +0100

Conclusions: The prehospital score could be a useful tool for deciding the refusal of ambulance transfer in Japan's emergency medical service system. (Source: BMC Emergency Medicine)

Ocular injuries in survivors of improvised explosive devices (IED) in commuter trains

BMC Emergency Medicine — Thu, 27 Sep 2007 04:00:00 +0100

Conclusions: Ophthalmologists and traumatologists should be aware of these patterns of ocular injuries. Protocols need to include the screening of large numbers of patients in a short time, diagnostic tests (B scan, visual evoked potential (VEP) etc) and early surgery preferably at the initial triage itself as most of the serious injuries in our studies had been missed or not treated at an initial assessment. (Source: BMC Emergency Medicine)

Quitline referral vs. self-help manual for tobacco use cessation in the Emergency Department: a feasibility study

BMC Emergency Medicine — Fri, 14 Sep 2007 04:00:00 +0100

Conclusions: Compliance with the QL intervention was encouraging and may hold promise for providing needed tobacco use counseling to ED patients. Future studies are required, and should focus on more effective mechanisms to obtain outcome measures and a larger sample size. Trial Registration: NCT00394420 (Source: BMC Emergency Medicine)

Comparison of a nurse initiated insulin infusion protocol for intensive insulin therapy between adult surgical trauma, medical and coronary care intensive care patients

BMC Emergency Medicine — Wed, 29 Aug 2007 04:00:00 +0100

Background: Sustained hyperglycemia is a known risk factor for adverse outcomes in critically ill patients. The specific aim was to determine if a nurse initiated insulin infusion protocol (IIP) was effective in maintaining blood glucose values (BG) within a target goal of 100-150 mg/dL across different intensive care units (ICUs) and to describe glycemic control during the 48 hours after protocol discontinuation. Methods: A descriptive, retrospective review of 366 patients having 28,192 blood glucose values in three intensive care units, Surgical Trauma Intensive Care Unit (STICU), Medical (MICU) and Coronary Care Unit (CCU) in a quaternary care hospital was conducted. Patients were > 15 years of age, admitted to STICU (n=162), MICU (n=110) or CCU (n=94) over 8 months; October 2003-June 2...

A new implicit review instrument for measuring quality of care delivered to pediatric patients in the emergency department

BMC Emergency Medicine — Wed, 22 Aug 2007 23:50:59 +0100

Background: There are few outcomes experienced by children receiving care in the Emergency Department (ED) that are amenable to measuring for the purposes of assessing of quality of care. The purpose of this study was to develop, test, and validate a new implicit review instrument that measures quality of care delivered to children in EDs. Methods: We developed a 7-point structured implicit review instrument that encompasses four aspects of care, including the physician's initial data gathering, integration of information and development of appropriate diagnoses; initial treatment plan and orders; and plan for disposition and follow-up. Two pediatric emergency medicine physicians applied the 5-item instrument to children presenting in the highest triage category to four rural EDs, and we a...

Failure of psychiatric referrals from the pediatric emergency department

BMC Emergency Medicine — Wed, 15 Aug 2007 04:00:00 +0100

Conclusions: Children screened in the ED for unrecognized mental health problems are very unlikely to follow-up for a mental health evaluation with or without an enhanced referral. Understanding the role of ED based mental health screening and the timing of an intervention is key in developing ED based mental health interventions. (Source: BMC Emergency Medicine)

Success of microvascular surgery: repair of mesenteric injury and prevention of short bowel syndrome:a case report

BMC Emergency Medicine — Tue, 14 Aug 2007 04:00:00 +0100

We present a 19-year-old boy with blunt abdominal trauma which caused serious mesenteric injury. Because ultrasound revealed free intraabdominal fluid, he underwent emergent laparotomy. Adequate vascularization of approximately 20 cm of proximal jejunal segment and approximately 20 cm of terminal ileum was observed. Nevertheless, the mesentery of the rest of the small intestine segments was ruptured completely. We performed an end-to-end anastomosis between a distal branch of the superior mesenteric artery in the mesentery of the ileal segment and a branch of the superior mesenteric artery using separate sutures of 7.0 monofilament polypropylene. The patient's gastrointestinal passage returned to normal on the postoperative day 2. He recovered without any complication and discharged from h...

Impact of Introducing Multiple Evidence-Based Clinical Practice Protocols in a Medical Intensive Care unit: A Retrospective Cohort Study

BMC Emergency Medicine — Wed, 08 Aug 2007 04:00:00 +0100

Conclusions: The introduction of multiple evidence-based protocols is associated with improved outcome in critically ill medical patients. (Source: BMC Emergency Medicine)

Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA): Design and rationale

BMC Emergency Medicine — Mon, 06 Aug 2007 04:00:00 +0100

This study aims to provide the evidence base for the development of a diagnostic algorithm that can act as a guideline for ED physicians to evaluate patients with acute abdominal pain. (Source: BMC Emergency Medicine)

Can latent heat safely warm blood? - in vitro testing of a portable prototype blood warmer

BMC Emergency Medicine — Wed, 01 Aug 2007 04:00:00 +0100

Conclusions: Using latent heat as an energy source can satisfactorily warm cold blood or other intravenous fluids to near body temperature, without any adverse affects. (Source: BMC Emergency Medicine)

A survey of knowledge, attitudes and practice of emergency contraception among university students in Cameroon

BMC Emergency Medicine — Tue, 17 Jul 2007 04:00:00 +0100

Conclusions: Awareness of emergency contraception pills by Cameroonian students is low and the method is still underused. Strategies to promote use of emergency contraception should be focused on spreading accurate information through medical and informational sources, which have been found to be reliable and associated with good knowledge on emergency contraceptive pills. (Source: BMC Emergency Medicine)

The utility of B-type natriuretic peptide in the diagnosis of heart failure in the emergency department: a systematic review

BMC Emergency Medicine — Tue, 26 Jun 2007 04:00:00 +0100

Conclusions: Our analysis suggests that BNP has moderate accuracy in detecting HF in the ED. Our results suggest utilizing a BNP of less than 100 pg/ml to rule out HF and a BNP of greater than 400 pg/ml to diagnose HF. Many studies were of marginal quality, and all included patients with varying degrees of diagnostic uncertainty. Further studies focusing on patients with diagnostic uncertainty will clarify the real-world utility of BNP in the emergency management of dyspnea. (Source: BMC Emergency Medicine)

A patient survey of out-of-hours care provided by Emergency Care Practitioners

BMC Emergency Medicine — Fri, 15 Jun 2007 04:00:00 +0100

Conclusions: Most patients treated at home by ECPs appeared satisfied and compliant with the care provided, according to the measures used in this study. However, it appears that a sizeable minority of patients were unclear about ECP assessments and it remains to be seen whether these patients had pre-existing health complaints which made them less likely to recover and more likely to seek hospital care, or whether the lack of clarity about their assessment undermined their subsequent recovery and necessitated hospital care. Further research is required to establish if the assessments provided by ECPs are less clear than those provided by other practitioners, and whether it is possible to ensure that all such assessments are clear to all patients. Patients hold a mainly positive view of o...

Postal survey methodology to assess patient satisfaction in a suburban emergency medical services system: an observational study.

BMC Emergency Medicine — Fri, 15 Jun 2007 04:00:00 +0100

Background: Patient satisfaction is of growing importance to providers of emergency medical services (EMS). Prior reports of patient satisfaction have frequently used resource-intensive telephone follow-up to assess satisfaction. We determine the feasibility of using a single mailing, anonymous postal survey methodology for collecting patient satisfaction data from a suburban EMS system. Methods: Patients transported between January 2001 and December 2004 were mailed a brief satisfaction questionnaire. The questionnaire was printed on a pre-addressed, postage paid postcard and consisted of five questions that used a five-point Likert scale to assess satisfaction with EMS personnel and services provided. Three open-ended questions assessed concerns, the most important service provided, and ...

Paediatric out-of-hospital resuscitation in an area with scattered population (Galicia-Spain).

BMC Emergency Medicine — Mon, 14 May 2007 04:00:00 +0100

Conclusions: Despite the handicap of a highly disseminated population, paediatric CRA characteristics and CPR results in Galicia are comparable to references from other communities. Programs to increase bystander CPR, equip laypeople with basic CPR skills and to update life support knowledge of health staff are needed to improve outcomes. (Source: BMC Emergency Medicine)

Study protocol: a randomised controlled trial of multiple and single dose activated charcoal for acute self-poisoning

BMC Emergency Medicine — Fri, 11 May 2007 04:00:00 +0100

Background: The case fatality for intentional self-poisoning in rural Asia is 10-30 times higher than in the West, mostly due to the use of highly toxic poisons. Activated charcoal is a widely available intervention that may - if given early - bind to poisons in the stomach and prevent their absorption. Current guidelines recommend giving a single dose of charcoal (SDAC) if patients arrive within an hour of ingestion. Multiple doses (MDAC) may increase poison elimination at a later time by interrupting any enterohepatic or enterovascular circulations. The effectiveness of SDAC or MDAC is unknown. Since most patients present to hospital after one hour, we considered MDAC to have a higher likelihood of clinical benefit and set up a study to compare MDAC with no charcoal. A third arm of SDAC ...

National study of United States emergency department visits for acute pancreatitis, 1993–2003

BMC Emergency Medicine — Mon, 22 Jan 2007 07:00:00 +0100

Conclusion: ED visits for acute pancreatitis are rising in the U.S., and ED visit rates are higher among blacks than whites. At many visits analgesics are not administered, and diagnostic imaging is rare. There was greater likelihood of admission among whites than blacks. The observed race disparities in ED visit and admission rates merit further study. (Source: BMC Emergency Medicine)

Clinical characteristics of emergency department heart failure patients initially diagnosed as non-heart failure

BMC Emergency Medicine — Tue, 14 Nov 2006 07:00:00 +0100

Background: Since previous studies suggest the emergency department (ED) misdiagnosis rate of heart failure is 10-20% we sought to describe the characteristics of ED patients misdiagnosed as non-decompensated heart failure in the ED. Methods: We analyzed a prospective convenience sample of 439 patients at 4 emergency departments who presented with signs or symptoms of decompensated heart failure. Patients with a cardiology criterion standard diagnosis of decompensated heart failure and an ED diagnosis of decompensated heart failure were compared to patients with a criterion standard of decompensated heart failure but no ED diagnosis of decompensated heart failure. Two senior cardiology fellows retrospectively determined the patients heart failure status during their acute ED presentation. ...

Gastric Lavage in Acute Organophosphorus Pesticide poisoning (GLAOP) – a randomised controlled trial of multiple vs. single gastric lavage in unselected acute organophosphorus pesticide poisoning

BMC Emergency Medicine — Thu, 19 Oct 2006 06:00:00 +0100

Discussionthe GLAOP study is a novel, prospective cohort study that will explore to the toxic kinetics of OP and effects of gastric lavage on it. Given the poor information about the impact of gastric lavage on clinical outcomes for OP patients, this study can provide important information to inform clinical practice. (Source: BMC Emergency Medicine)

Are they really refusing to travel? A qualitative study of prehospital records

BMC Emergency Medicine — Tue, 19 Sep 2006 06:00:00 +0100

Conclusions: A system that facilitates standardised recording of RTT information including social reasons for non-transportation needs to be designed. Refused to travel disclaimers need to reflect instances when crew and patient are satisfied that not going to hospital is the right outcome. These recommendations should be considered within the context of the plans for widening the role of ambulance services. (Source: BMC Emergency Medicine)

The insecure airway: a comparison of knots and commercial devices for securing endotracheal tubes

BMC Emergency Medicine — Wed, 24 May 2006 06:00:00 +0100

Conclusions: Among devices tested, the Dale(R) was most secure. Within the scope offered by the small sample sizes, there were no statistically significant differences between the knots in this study. (Source: BMC Emergency Medicine)

Direct hospital costs of chest pain patients attending the emergency department: a retrospective study

BMC Emergency Medicine — Thu, 04 May 2006 06:00:00 +0100

Conclusion: Costs for chest pain patients are large and primarily due to admission time. The present admission practice seems to be cost-effective, but the substantial overadmission indicates that better ED diagnostics and triage could decrease costs considerably. (Source: BMC Emergency Medicine)

Life-threatening intoxication with methylene bis(thiocyanate): clinical picture and pitfalls. A case report

BMC Emergency Medicine — Tue, 11 Apr 2006 06:00:00 +0100

We describe the first case of severe intoxication following inhalation of powder in an industrial worker. Profound cyanosis and respiratory failure caused by severe methemoglobinemia developed within several minutes. Despite immediate admission to the intensive care unit, where mechanical ventilation and hemodialysis for toxin elimination were initiated, multi-organ failure involving liver, kidneys, and lungs developed. While liver failure was leading, the patient was successfully treated with the MARS (molecular adsorbent recirculating system) procedure. (Source: BMC Emergency Medicine)

Validation of the Ottawa Ankle Rules in Iran: A prospective survey

BMC Emergency Medicine — Thu, 16 Feb 2006 07:00:00 +0100

Conclusion: OARs are very accurate and highly sensitive tools for detecting ankle fractures. Implementation of these rules would lead to significant reduction in the number of radiographs, costs, radiation exposure and waiting times in emergency departments. (Source: BMC Emergency Medicine)

Errors in fracture diagnoses in the emergency department – characteristics of patients and diurnal variation

BMC Emergency Medicine — Thu, 16 Feb 2006 07:00:00 +0100

Conclusion: A considerable number of fractures were not correctly diagnosed at the initial ED visit. There was a diurnal variation in the rate of misdiagnosis of fractures with a significant peak from 8 pm to 2 am. Where there was an error in fracture diagnosis, the patients did not appear to have a characteristic profile as regarding e.g. age, sex or capability to communicate with the ED staff. Increased consultancy service in radiology may reduce the frequency of errors in diagnosis, particularly in the evenings between 8 pm and 2 am. (Source: BMC Emergency Medicine)

The initial Mayo Clinic experience using high-frequency oscillatory ventilation for adult patients: a retrospective study

BMC Emergency Medicine — Tue, 07 Feb 2006 07:00:00 +0100

Conclusion: During our first year of experience, HFOV was used as a rescue therapy in very sick patients with refractory hypoxemia, and improvement in oxygenation was observed after 24 hours of this technique. HFOV is a reasonable alternative when a protective lung strategy could not be achieved on conventional ventilation. (Source: BMC Emergency Medicine)

Short-term elevation of intracranial pressure does neither influence duodenal motility nor frequency of bolus transport events: a porcine model

BMC Emergency Medicine — Wed, 25 Jan 2006 07:00:00 +0100

Conclusion: The present study suggests that a stepwise and hourly increase of the intracranial pressure of up to 50 mmHg, does not influence duodenal motility activity in a significant manner. A considerable deterioration of the duodenal mucosal blood flow was excluded by determining the lactate to pyruvate ratio. (Source: BMC Emergency Medicine)

Simple technique for evacuation of traumatic subcutaneous haematomas under tension

BMC Emergency Medicine — Tue, 13 Dec 2005 07:00:00 +0100

Conclusion: The technique is useful as an urgent and safe procedure in the accident and emergency department setting. (Source: BMC Emergency Medicine)

Flecainide overdose – support using an intra-aortic balloon pump

BMC Emergency Medicine — Mon, 12 Dec 2005 07:00:00 +0100

Conclusion: The use of an intra-aortic balloon pump is a useful supportive measure during the acute phase of flecainide overdose associated with severe myocardial depression. (Source: BMC Emergency Medicine)

A meta-analysis of controlled trials of recombinant human activated protein C therapy in patients with sepsis

BMC Emergency Medicine — Fri, 14 Oct 2005 06:00:00 +0100

Conclusion: This meta-analysis, therefore, raises doubts about the clinical usefulness of recombinant activated protein C in patients with severe sepsis and an APACHE II score ≥ 25 which can only be resolved by another properly designed clinical trial. (Source: BMC Emergency Medicine)

Early tracheostomy in closed head injuries: experience at a tertiary center in a developing country – a prospective study

BMC Emergency Medicine — Fri, 14 Oct 2005 06:00:00 +0100

Background: An important factor contributing to the high mortality in patients with severe head trauma is cerebral hypoxia. The mechanical ventilation helps both by reduction in the intracranial pressure and hypoxia. Ventilatory support is also required in these patients because of patient's inability to protect the airway, persistence of excessive secretions, and inadequacy of spontaneous ventilation. Prolonged endotracheal intubation is however associated with trauma to the larynx, trachea, and patient discomfort in addition to requirement of sedatives. Tracheostomy has been found to play an integral role in the airway management of such patients, but its timing remains subject to considerable practice variation. In a developing country like India where the intensive care facilities are ...

Pseudo-aneurysm of the anterior tibial artery, a rare cause of ankle swelling following a sports injury

BMC Emergency Medicine — Fri, 14 Oct 2005 06:00:00 +0100

Conclusion: Vascular injuries remain a rare cause of ankle pain and swelling following sports injuries, however it is important to consider these injuries when no definite musculo-skeletal cause is found. Ultrasound duplex and Transfemoral arteriogram are appropriate, sensitive modalities for investigation, and may allow novel treatment to be directed percutaneously. Early diagnosis and intervention are essential for the successful outcome in these patients. (Source: BMC Emergency Medicine)

Which diagnostic tests are most useful in a chest pain unit protocol?

BMC Emergency Medicine — Thu, 25 Aug 2005 06:00:00 +0100

Conclusion: Serial ECG / ST monitoring, as used in our protocol, adds little diagnostic or prognostic value in patients with a normal or non-diagnostic initial ECG. CK-MB(mass) can rule out ACS with clinical myocardial infarction but not myocyte necrosis(defined as a troponin elevation without myocardial infarction). Using a low threshold for positivity for troponin T improves sensitivity of this test for myocardial infarction and myocardial necrosis. Exercise treadmill testing predicts subsequent adverse cardiac events. (Source: BMC Emergency Medicine)