European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Emergency medical personnel are at risk of secondary contamination when treating victims of chemical-biological-radiological-nuclear incidents. Hence, it is crucial to train them on the appropriate management of patients involved in chemical-biological-radiological-nuclear incidents. Personal protective equipment (PPE) plays an important role in treating patients suffering from various types of poisoning. However, very few studies have examined whether the use of PPE impedes airway management in an emergency department setting. The present study evaluated the effect of PPE on physicians' performance of emergency airway management using mannequins. ⋯ Protective equipment had no effect on physicians' emergency airway placement time. The effect of wearing PPE is limited if postintubation care is excluded from the evaluation. Furthermore, intubation experience influenced participants' preferred approach for airway management.
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In previous studies including patients with suspected cardiac chest pain, those who had acute myocardial infarction (AMI) reported more severe chest pain than those without AMI. However, many patients with AMI present with very mild pain or discomfort. We aimed to investigate whether peak pain severity, as reported by patients in the Emergency Department, has any potential role in the risk stratification of patients with suspected cardiac chest pain. ⋯ Pain score has limited diagnostic value for AMI. Scores should guide analgesia but shift the probability of AMI very little, and should not guide other clinical management.
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Observational Study
Do physiological scoring and a novel point of care metabolic screen predict 48-h outcome in admissions from the emergency department resuscitation area?
We aimed to compare the performance of a widely used physiological score [Modified Early Warning Score (MEWS)] and a novel metabolic score (derived from a blood gas) in predicting outcome in emergency department patients. ⋯ This pilot data suggest that a blood gas-derived metabolic score on emergency department arrival may be superior to MEWS at predicting organ failure and death at 48 h.
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Acute urinary retention (AUR) is a common presentation to emergency departments. This article updates the reader on the appropriate management, investigations and guidelines for AUR. ⋯ It outlines urethral catheterization techniques for difficult cases, reviews suprapubic catheterization procedures and describes the management of AUR in polytrauma. Although emergency management is by bladder drainage, key points in the history and examination may expose significant, latent pathologies.
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Randomized Controlled Trial Comparative Study
Comparison of the Airtraq laryngoscope versus the conventional Macintosh laryngoscope while wearing CBRN-PPE.
The rapid management of respiratory failure after exposure to a CBRN agent (chemical, biological, radiological and nuclear) is a priority leading to a decrease in mortality. We studied the performance of orotracheal intubation (OTI) with the Airtraq laryngoscope compared with the Macintosh laryngoscope by emergency physicians in protective CBRN type III personal protective equipment. ⋯ This study on manikins shows that the Macintosh laryngoscope is superior to the Airtraq laryngoscope in terms of OTI speed, efficiency, and overall ease of use. The Macintosh device is one of the alternatives in the OTI of normal airways by emergency doctors in CBRN personal protective equipment clothing.