Emergency medicine journal : EMJ
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Multicenter Study
Survey of attitudes of senior emergency physicians towards the introduction of emergency department ultrasound.
Emergency department ultrasound (EDU) is widely practised in the USA, Australia, parts of Europe, and Asia. EDU has been used in the UK since the late 1990s but as yet, few areas have established a practice. ⋯ Despite the vast majority of ED consultants being in favour of EDU, very few actually perform it on a regular basis or have had any formal training. Highlighted difficulties in EDU implementation included financial constraints, lack of support from radiology departments, and lack of formal training.
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A short cut review was carried out to establish whether primary split skin grafting is better than simple wound edge approximation at reducing time to healing in patients with pretibial flap lacerations. A total of 72 papers were found using the reported search, of which one 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 this best paper are tabulated. A clinical bottom line is stated.
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Multicenter Study
A review of emergency equipment carried and procedures performed by UK front line paramedics on paediatric patients.
In 1997 a review of paramedic practice upon adult patients in the UK found many inconsistencies and deficiencies in basic care. A follow up review in 2002 identified widespread improvement in provision of equipment and skills to provide basic and advanced life support.Paediatric care was not assessed in either review. The authors conducted this study to identify current standards of care in paediatric paramedic practice and areas of potential improvement. ⋯ Ambulance Trusts not meeting standards set out in the JRCALC guidelines must address their areas of deficiency. Failure to do so endangers children's lives and leaves Trusts open to criticism.
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Cranial computed tomography (CT) is replacing skull radiography in head trauma. Rapid radiological opinions on these images may not always be available. We assessed the ability of our permanent emergency department staff to interpret the images. ⋯ Our results for CT scans are similar to studies of interpretation of other radiographic images in emergency departments. Our emergency staff could safely make the initial interpretation of cranial CT images in trauma out of hours, and formal reporting may wait until a suitably experienced radiologist is available.
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Most sternal fractures are transverse, and a lateral chest radiograph is diagnostic. We report a case of vertical sternal fracture that was not seen on plain radiographs but was revealed using computed tomography (CT). Thoracic CT with coronal reformatted images can also demonstrate sternal fracture lines, supernumerary synchondrosis, and costosternal joint abnormalities.