European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Pediatric emergency medicine (PEM) has been developing rapidly but heterogeneously in many European countries in recent years, and many national PEM societies have been founded to improve the quality of care of ill and injured children and adolescents. Key facets of any such improvement are the development, delivery and translation of high-quality research. ⋯ Multicentre research carried out in this way will bring about improvements in the quality of emergency care for children in European emergency departments, and result in a better quality of life for children and adolescents. This paper outlines the background and achievements of REPEM to date and describes the current structure and next steps.
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Comparative Study Observational Study
Can a change in pH and pCO2 be used to monitor progress in patients undergoing noninvasive ventilation? A prospective cohort study.
The aim of this study was to compare changes in arterial and venous pH and pCO2 in patients undergoing noninvasive ventilation and having serial blood gases to assess ventilatory function. This was a prospective observational study of patients with acute respiratory distress. The outcome of interest was agreement in change in pH and pCO2 between arterial and venous specimens [mean difference; 95% limits of agreement (LoA)]. ⋯ The agreement between absolute change is reasonable for pH but not for pCO2. The direction of change agreed in most cases. Changes in venous pH and pCO2, in combination with clinical assessment, may be useful for assessing progress in patients undergoing noninvasive ventilation.
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Adverse drug reactions (ADRs) to N-acetylcysteine (NAC) treatment for paracetamol overdose are typically anaphylactoid in origin and occur in 2-48% of treated patients. We explored the incidence and management of NAC ADR in our unit. ⋯ The incidence of ADR to NAC was comparable with published studies, although there was no association of severity with asthma or female sex. The management of ADRs is variable, with frequent, inappropriate use of steroids. Education about the pathophysiology of these ADRs may improve management.
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To derive and validate a new scoring system to predict in-hospital mortality in septic patients in the emergency department (ED). ⋯ The MISSED score should be used in the ED.
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The aim of this study was to analyze the current practices on acute pain management of patients under opioid maintenance treatment (OMT), that is, buprenorphine or methadone. A total of 706 physicians were solicited through a national network to answer a survey about pain perception and analgesic strategies. Among the prescribers, 323 (46%) answered the survey: 131 (40%) physicians estimated that patients under OMT when exposed to an acute painful event feel more pain than other patients and 170 (53%) estimated that the patients felt the same amount of pain. ⋯ Among the second-line analgesic drugs, the WHO step 3 analgesics (mainly morphine) were the most commonly reported [221 physicians (68%)]. Overall, the results demonstrate the misconceptions of physicians on the pain tolerance of patients under OMT. Clinical studies and evidence-based guidelines are necessary to improve the therapeutic strategies for such patients in an emergency setting.