Emergency medicine journal : EMJ
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Effective resuscitation includes the rapid identification and correction of an inadequate circulation. Shock is said to be present when systemic hypoperfusion results in severe dysfunction of the vital organs. The finding of normal haemodynamic parameters, for example blood pressure, does not exclude shock in itself. This paper reviews the pathophysiology, resuscitation, and continuing management of the patient presenting with shock to the emergency department.
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Comparative Study
Prehospital trauma management: a national study of paramedic activities.
The benefits of prehospital trauma management remain controversial. This study aimed to compare the processes of care and outcomes of trauma patients treated by paramedics, who are trained in advanced prehospital trauma care, with those treated by ambulance technicians. ⋯ This large scale national study shows that paramedics show good triage skills and clinical judgement when managing trauma patients. However, the value of the individual interventions they perform could not be ascertained. Further controlled trials are necessary to determine the true benefits of advanced prehospital trauma life support.
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Comparative Study
Securing the prehospital airway: a comparison of laryngeal mask insertion and endotracheal intubation by UK paramedics.
The recent introduction of a disposable laryngeal mask airway has provided paramedics with an alternative to endotracheal intubation. Time taken to secure the airway with each device was compared in patients undergoing elective surgery. ⋯ Even under optimal conditions, 30% of attempts at intubation by paramedics were unsuccessful. A disposable laryngeal mask has a higher success rate in securing the airway and overall, secures the airway more reliably than endotracheal intubation.
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Comparative Study
The efficacy of structured assessment and analgesia provision in the paediatric emergency department.
To ascertain if the use of a structured pain assessment tool and nurse initiated oral analgesia protocols improve uptake and time to analgesia for children presenting to the emergency department with minor or moderate musculoskeletal injuries. ⋯ The use of a nurse initiated, oral analgesia protocol for treatment of children with mild to moderate injury can significantly increase analgesia provision rates and decrease time to provision of analgesia.
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This review examines the present understanding of tension pneumothorax and produces recommendations for improving the diagnostic and treatment decision process.