Emergency medicine journal : EMJ
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A short cut review was carried out to establish the utility of troponin levels in diagnosing myocardial contusion following blunt chest trauma. Using the reported search, 75 papers were found, of which six presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
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Multicenter Study
Urban legend versus rural reality: patients' experience of attendance at accident and emergency departments in west Wales.
To investigate why and how patients decide to attend accident and emergency (A&E) departments, and to assess their satisfaction with the experience, in a predominantly rural west Wales population. ⋯ Anecdotal accounts of abuse of A&E services and unreasonable patient expectations gain the status of "urban legends" within the medical profession. Among the predominantly settled rural population in west Wales, there is little evidence of unreasonable patient expectations, and most patients report high satisfaction levels. Patients' bad experiences most frequently arise from a dismissive attitude on the part of medical staff. These attitudes are often consequent on an A&E culture that views some patients' attendances as less appropriate than others.
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Review
Should ultrasound guidance be used for central venous catheterisation in the emergency department?
In September 2002, the National Institute of Clinical Excellence (NICE) issued guidelines for England and Wales suggesting that ultrasound guidance should be used for all electives, and should be considered for most emergency, central venous catheterisations.1 These guidelines propose a major change of practice for most clinicians practising in UK Emergency Departments. There are also resource and training implications. In this paper we systematically review the literature to establish what evidence exists for the routine use of ultrasound guidance in the placement of central venous catheters in adult patients attending the Emergency Department, and provide an overview of the practical elements of this procedure.
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Randomized Controlled Trial Clinical Trial
Limited benefits of ambulance telemetry in delivering early thrombolysis: a randomised controlled trial.
To evaluate the potential of a continuous telemetry system linking rural ambulances to a coronary care unit to reduce call to thrombolysis times. ⋯ Continuous telemetry systems may significantly reduce call to treatment times for patients recommended for pre-hospital thrombolysis in a rural setting. However, this benefit must be balanced against the very small proportion of eligible patients identified as suitable for pre-hospital thrombolysis. This limitation may be due to communications problems, the criteria used to identify eligible patients, or the seniority of physicians tasked with making treatment decisions.
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Emergency medical service systems in Norway are based on equity and equality. A toll free number (113) and criteria based dispatch are crucial components. The establishment of an emergency medical system (EMS) manned by an air and ground emergency physician (EP) has challenged the role of the general practitioner (GP) in emergency medical care. We investigated whether there were any geographical differences in the use of 113, alerts to GPs by the emergency medical dispatch centres (EMDCs), and of the presence of GPs on scene in medical emergencies leading to a turnout of the EP manned EMS. ⋯ We found geographical differences in the involvement of GPs in pre-hospital emergency medical situations, probably caused by a specialised emergency medical service system including an EMDC and an air and ground EP manned EMS. There were geographical differences in public use of the toll free 113, and alerts to GPs by the EMDCs, which is likely to result from geographical conditions and proximity to medical resources. Future organisation of the EMS has to reflect this to prevent unplanned and unwanted autonomously emerging EMS systems.