European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The objective of this study is to determine the incidence of emergency department (ED) visits for acute allergic reactions, identify the triggers, assess the severity, evaluate the management practices, and examine patient outcomes at a single-center ED in Lebanon. ⋯ The incidence of ED visits for acute allergic reaction was high compared with other studies, although the majority of cases were mild. Deviations from published guidelines on the treatment of anaphylaxis are common, with rare use of epinephrine and heavy reliance on H1-antihistamines both in the ED and at discharge. This did not seem to result in any measurable impact on mortality.
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Despite now being rarely used in the prehospital and emergency department arena because of their excessive length and low inner diameter, narrow-bore central venous catheters (CVC) are sometime used to perform fluid resuscitation using a rapid infusion pump to enhance delivered flow. In this bench study, we tested the hypothesis that the delivered flow rate downstream from the catheter connected to a rapid infusion pump would be significantly lower than the preset flow rate, and this difference would be affected by the catheter size. ⋯ Using a rapid infusion device, the delivered flow rate was lower than the preset flow rate. Even PVCs are better than narrow-bore CVC, neither is the most suitable cannula for patients requiring massive resuscitation.
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Comparative Study
Air versus ground transport of patients with acute myocardial infarction: experience in a rural-based helicopter medical service.
Primary prehospital Helicopter Emergency Medical Service (HEMS) interventions may play a role in timely reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI). We designed a prospective study involving patients with acute myocardial infarction aimed at the evaluation of the potential benefit of such primary HEMS interventions as compared with classical Emergency Medical Services ground transport. ⋯ Using HEMS in a rural region allows STEMI patients to benefit from appropriate rescue care with delays similar to those seen in urban settings.
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Observational Study
Emergency dispatch process and patient outcome in bystander-witnessed out-of-hospital cardiac arrest with a shockable rhythm.
To describe the dispatch process for out-of-hospital cardiac arrest (OHCA) in bystander-witnessed patients with initial shockable rhythm, and to evaluate whether recognition of OHCA by the emergency medical dispatcher (EMD) has an effect on the outcome. ⋯ The rate of recognition of cardiac arrest by EMD was high, but EMD recognition did not affect the outcome. The survival rate was high in both groups. Recognized cardiac arrest patients received bystander CPR more frequently than those for whom OHCA remained unrecognized.
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The aim of this study was to evaluate which factors are associated with early hospital arrival and help-seeking delays in acute stroke. All consecutive eligible patients were interviewed face-to-face within 72 h of admission. Factors associated with early arrival were assessed by univariate and multivariate analysis. ⋯ The most common reasons for delaying seeking help were the hope for spontaneous recovery and perceiving the elapsed time as insignificant. The patients who call their family physician lose valuable time and their chance for thrombolysis. Many patients probably neglect symptoms because of stroke itself and therefore do not act fast enough.