European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Observational Study
Anaesthesiologist-provided prehospital airway management in patients with traumatic brain injury: an observational study.
Guidelines recommend that patients with brain trauma with a Glasgow Coma Scale (GCS) score of less than 9 should have an airway established. Hypoxia, hypotension and hypertension as well as hypoventilation and hyperventilation may worsen outcome in these patients. ⋯ The guideline adherence was high. The incidences of post-RSI hypoxia and systolic blood pressure below 90 compare with the results reported from other physician-staffed prehospital services. The incidence of systolic blood pressure below 120 as well as that of hyperventilation following prehospital endotracheal intubation in patients with traumatic brain injury call for a change in our current practice.
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Anecdotally it has been noted that the traditional chest signs associated with bronchiolitis appear inconsistently in infants clinically diagnosed with bronchiolitis. We wished to explore this more formally. ⋯ Clinical signs associated with bronchiolitis vary according to age. Infants older than 6 months are more likely to present with wheeze and infants less than 4 months old are likely to present without chest signs on auscultation.
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The main purpose of this article is to provide some practical insights into acid-base disorders interpretation, comparing the three most widespread diagnostic approaches. After a brief summary of the history of blood gas analysis and the shift from a purely chemical approach to more clinically useful applications, the pros and cons of the different methodologies are compared and discussed. Reviewing the most important publications in the field, the authors attempt to show that each diagnostic strategy is acceptable, although the one based on base-excess calculation perhaps seems too 'rough' to understand the mixed disorders, whereas the Stewart approach is attractive from a chemical point of view, but unsuitable for the emergency physician because of the cumbersome calculations needed. Finally, the anion gap and 'expected compensation' approach seems to be more comprehensive and feasible at the bedside.
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Randomized Controlled Trial Comparative Study
Quality of resuscitation by first responders using the 'public access resuscitator': a randomized manikin study.
The CAREvent Public Access Resuscitator (PAR) is an electronic, oxygen-driven cardiopulmonary resuscitation (CPR) device allowing volume-controlled ventilation with a face mask and guiding the rescuer through the resuscitation with voice prompts and visual indications. We hypothesized that 1 year after initial training, the efficacy of ventilation skills (primary outcome) and compression skills (secondary outcome) by first responders using the PAR would be superior compared with CPR with only a face mask. ⋯ Compared with the face mask, PAR improved tidal volume, compressions per minute and hand position in a manikin setting.
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The aim of this study was to describe the aetiology and severity of head injury in an infant (age<1 year) population presenting to a Scottish Paediatric Emergency Department (PED) and to discern preventable risk factors. The records of infants who presented to the PED of the Royal Aberdeen Children's Hospital between September 2010 and December 2011 with isolated head trauma were reviewed, patient demographics were extracted and information on aetiology, including nonaccidental injury (NAI), was recorded. Of 1574 attendances, 233 suffered isolated head injury. ⋯ The most common mode of injury was fall from a height (37%). Infants commonly present to the PED with head injury, many of which should be easily preventable. The number of cases because of NAI in our population is smaller than previously published figures.