European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Randomized Controlled Trial
Antibiotic prophylaxis at triage for simple traumatic wounds: a pilot study.
Antibiotic administration at the time of wound manipulation has not been shown to decrease infection rates for simple traumatic wounds. Antibiotic administration at the time of initial emergency department (ED) presentation, however, has not been explored. Patients presenting to the ED with simple traumatic wounds received 1 g of oral flucloxacillin, or identical placebo, at triage. ⋯ Time from drug administration to wound manipulation was 64.3 min [95% confidence interval (CI) 36.6-91.9] placebo versus 75.0 min (95% CI: 51.7-98.3) flucloxacillin, P=0.657. Six of 36 patients (17%) reported wound infection in the placebo group, and four of 34 (12%) in the flucloxacillin group, P=0.736. Administration of oral flucloxacillin at triage failed to reduce the rate of wound infection for simple traumatic wounds closed in the ED.
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Comparative Study
Unplanned return visit to emergency department: a descriptive study from a tertiary care hospital in a low-income country.
The objective of this study was to determine the incidence, causes, and factors associated with unplanned return visits to emergency department of a tertiary care centre in a low-income country. We conducted a retrospective chart review of all patients who had unplanned returned visit to our emergency department within 48 h of their initial visit during a 1-year study period. The incidence of unplanned revisits is 2%. ⋯ During return visits 55% of patients required admission. On multivariable logistic regression model; fever, triage categories 1 and 2, and patients leaving against medical advice were the independent risk factors for revisits requiring admission. Infectious diseases are the leading cause of return visits in our setting.
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To describe the rates of surgery and nonoperative management (NOM) for patients with blunt splenic trauma in a district general hospital. ⋯ Rates of blunt splenic trauma in a district general hospital remain low with acceptable rates of NOM. Hypotension within 60 min of hospital arrival may be a useful predictor of the need for surgery.
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In this study we aimed to determine whether isosorbide dinitrate (ISDN) bolus is associated with hypotension in patients aged at least 75 years presenting to an emergency department (ED) with acute heart failure (AHF) syndrome. This is a retrospective study, and all patients with AHF presenting in our ED during 2007 were included. We included 136 patients: 25 (18%) of them received ISDN in bolus (group B) among other treatments, and 111 (82%) did not (group O). ⋯ The mean lower systolic blood pressure after treatment was similar: 116±18 mmHg in group O compared with 116±19 mmHg in group B+, and was less than 90 mmHg in 0% cases in group B+ versus 3% in group O (P=0.5). Secondary endpoints were not significant, with mortality in group B of 4% versus 10% in group O (P=0.32). ISDN is not associated with more hypotension when used in bolus for elderly patients treated in the ED for AHF.
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The objective of this study was to analyze the prehospital use of a Glidescope video laryngoscope (GSVL) due to anticipated and unexpected difficult airway in a helicopter emergency medical service setting in which emergency physicians (EP) are experienced anesthetists. Retrospective observational study and survey of the experiences of EP were conducted for more than a 3-year period (July 2007-August 2010). In 1675 missions, 152 tracheal intubations (TI) were performed. ⋯ In two patients, the EP required two attempts with GSVL to obtain a successful TI. Since the introduction of the GSVL, no other backup airway device was necessary. GSVL may be a valuable support instrument in the prehospital management of difficult airways in emergency patients.