European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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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 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.
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Toddler's fracture (TF) occurs in young children after minor trauma. Clinical diagnosis can be challenging and initial radiological evidence may be lacking. The aim of this study was to compare the management and outcomes of clinically diagnosed TF patients with and without initial radiological evidence. ⋯ There were no complications with management in or out of cast. The initial presumptive clinical diagnosis of TF may be as significant as that with radiological confirmation. Follow-up imaging is unlikely to affect management if the diagnosis remains clinically clear.
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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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Community-acquired pneumonia (CAP) is associated with high in-hospital mortality. Standardization of diagnostics and adherence to sepsis bundles in the emergency department (ED) are associated with reduced mortality in patients with sepsis. We examined whether introduction of standardized care bundles and checklists in the ED is associated with reduced mortality in patients hospitalized for CAP. ⋯ This study demonstrated that implementation of standardized CAP care bundles in the ED is associated with a 21% relative risk reduction of in-hospital mortality. Standardization of diagnostic and therapeutic processes in the ED improves outcome of patients hospitalized for CAP.