European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Clinical Trial
Causes of diplopia in the emergency department: diagnostic accuracy of clinical assessment and of head computed tomography.
Studies on frequency and underlying diseases causing binocular diplopia in patients presenting to the emergency department (ED) are lacking. ⋯ One-third of diplopic patients had secondary diplopia. In patients with isolated diplopia, UHCT does not increase diagnostic sensitivity. In patients with associated neurological signs or symptoms, the prevalence of secondary diplopia was high and UHCT showed incremental diagnostic value.
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Observational Study
Procalcitonin as a biomarker for early sepsis in the emergency department.
In the critical care setting, increasing levels of midregional proadrenomedullin (MRproADM), midregional proatrial natriuretic peptide (MRproANP), procalcitonin (PCT), copeptin, and proendothelin-1 (proET-1) have been shown to be correlated with increasing severity of sepsis. The objective of this study was to investigate the utility of sepsis biomarkers in an Emergency Department (ED) population. ⋯ In this pilot study, we found that the combination of SIRS criteria and PCT levels is useful for the early detection of sepsis in ED patients with suspected infection. Larger studies investigating use of PCT are necessary.
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The aim of this study was to describe the mechanism and severity of injuries in the paediatric population treated by an Australian helicopter emergency medical service and to examine the frequency and nature of interventions performed. This information is important for planning education and continuing professional development in prehospital medicine. ⋯ Paediatric prehospital patients can be of high dependency, requiring urgent critical care procedures. Training in prehospital medicine should include paediatrics. It is essential that practitioners maintain skills in venous access, airway management and provision of adequate analgesia in children.
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Observational Study
Peripheral venous and arterial lactate agreement in septic patients in the Emergency Department: a pilot study.
Lactate measurements are routinely used in sepsis for prognostication and for guiding treatment. Although venous lactate measurements have widely been used, most studies have used arterial lactate (A-LACT). The interchangeability between the measurements is debatable. ⋯ The mean difference between the measurements (venous-arterial) was 0.54 mmol/l, with 95% limits of agreement of -0.11 to 1.18 mmol/l. This pilot study demonstrates the potential use of PV-LACT as a substitute for A-LACT measurement in septic ED patients. However, further definitive investigation is needed to support widespread clinical adoption of peripheral venous lactate.
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There are no prospective data on which ischemic stroke patients require endotracheal intubation. This retrospective observational study describes the characteristics and outcomes of adult ischemic stroke patients admitted to two emergency department (ED)-ICU from January 2005 to October 2011 and who were intubated before imaging, either during the prehospital or the ED phase of care. Data were extracted from hospital charts and analyzed using descriptive statistics. ⋯ Twenty-six patients (84%) died during their hospital stay. The proportion of ED ischemic stroke patients intubated before imaging was very low. Almost all were severely ill and the majority died.