European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Randomized Controlled Trial Comparative Study
Use of the TrachView videoscope as an adjunct to direct laryngoscopy for teaching orotracheal intubation.
The main objectives of this study were to assess the ease of the use of the TrachView videoscope and to compare it with direct laryngoscopy (DL) for teaching orotracheal intubation to emergency medicine (EM) medical students. Thirty-seven EM students with no earlier intubation experience were asked to intubate a manikin's trachea using DL alone and DL in combination with the TrachView. This investigation involved a randomized, cross-over study design and each trainee received a 10-min demonstration with each technique before the beginning of the study. ⋯ However, the POGO score improved to 90% (range, 15-100%) with the addition of the TrachView device (P<0.001). The TrachView was considered easy to use by a majority of the EM students and improved visualization of the vocal cords compared with DL alone. The time to achieve successful intubation of the manikin's trachea was shorter when the TrachView was used as an adjunct to DL.
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Review Case Reports
Carotid artery dissection: three cases and a review of the literature.
Carotid artery dissections are potentially disabling, probably underdiagnosed, and mainly affect young-aged and middle-aged people. We present three consecutive cases illustrating different clinical presentations and thereby emphasizing the diagnostic challenge of carotid artery dissections for the emergency physician. ⋯ Clinical vigilance is of utmost importance as early diagnosis and timely treatment favor long-term prognosis and even prevent ischemic complications. We review the literature and discuss the pathophysiology, etiology, clinical presentation, diagnosis, imaging techniques, treatment, and prognosis of carotid dissections.
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Wrist injuries are a common presentation to emergency departments. A clinical pathway has recently been introduced in our institution for patients with clinical suspicion of a scaphoid injury, using computed tomography (CT) at 2 weeks postinjury to rule out scaphoid fracture. However, it is not known what happens to patients who have a normal CT after such an injury. The aim of this pilot study was to assess disability after CT-negative wrist injuries. ⋯ The majority of these patients recover from their injury, but a small proportion with normal CT scans have considerable disability 12 months after injury. Appropriate advice should be given to these patients to enable them to access further investigation and treatment.
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To design an effective, efficient, and affordable radiation surveillance system to screen every emergency department (ED) visitor before they enter the ED. ⋯ Radiation threat to the ED, although uncommon, is real. For the safety of everyone in the ED, you can install an effective, efficient, but affordable surveillance system similar to ours if your ED is not exempted from this threat.
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Comparative Study
The First View Concept: introduction of industrial flow techniques into emergency medicine organization.
The number of patients seeking treatment in emergency departments is rising, although many governments are seeking to reduce expenditure on health. Emergency departments must achieve more with the same resources or perform the same functions with fewer resources. Patients demand higher emergency clinical care quality, with low waiting times viewed as a key quality criterion by many patients. ⋯ After introduction, 3269 patients had a median waiting time before first specialty physician contact of 11.2 min, a first quartile waiting time of 9.1 min, and a third quartile waiting time of 15.2 min. Industrial flow concepts can achieve significant improvements in emergency department workflows in countries in which sufficient numbers of specialty physicians are available. More attention to the organization of emergency department working processes is needed, especially involving lean management.