European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Multicenter Study Observational Study
Observational study in healthy volunteers to define interobserver reliability of ultrasound haemodynamic monitoring techniques performed by trainee doctors.
Bedside ultrasound is increasingly being used to guide fluid management in shocked patients. Little data exist on the inter-rater reliability of techniques used, especially when performed by nonexpert trainee doctors. The primary aim of this study is to measure the inter-rater reliability of five ultrasound techniques commonly used to guide fluid management: inferior vena cava collapsibility index (IVCCI), transthoracic echocardiography (TTE)-derived stroke volumes, ultrasound cardiac output monitor (USCOM) derived stroke volume and carotid artery blood flow and corrected flow time measurements. ⋯ TTE-derived measurements showed the highest level of inter-rater reliability and can thus be expected to provide reliable measures over time with different sonographer clinicians. USCOM interobserver reliability was also adequate for clinical use. However, on the basis of inter-reliability measures, IVCCI and carotid artery measurements were found to be inadequate for clinical use.
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Comparative Study
Appropriate use of laboratory test requests in the emergency department: a multilevel intervention.
Laboratory test requests in the emergency department (ED) are increasing worldwide. We evaluated whether a multilevel intervention on the basis of the optimization of test profiles and educational meetings with physicians could reduce the number of tests ordered. ⋯ Optimization of test profiles and education on the costs and appropriate use of the tests significantly reduced laboratory test ordering and costs without affecting ED and laboratory performances.
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Observational Study
Trendelenburg position in the ED: many critically ill patients in the emergency department do not tolerate the Trendelenburg position.
Critically ill patients in emergency departments (ED) frequently require catheterization of the internal jugular vein. For jugular insertion, the Trendelenburg position (TP) is recommended. However, many patients in the ED do not tolerate lying in the supine or even the head-down position, or TP is contraindicated for other reasons. The aim of our trial was to investigate to which extent TP is either not tolerated or contraindicated in the target population of patients admitted to the ED. ⋯ For central venous catheterization, TP remains the gold standard. Our trial shows the limitations of this positioning for critically ill patients. Almost 40% of the patients could not be tilted 15° head-down. Therefore, guideline recommendations should be reconsidered and alternatives should be sought.