Emergency medicine journal : EMJ
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Review Case Reports
Critical care in the emergency department: severe sepsis and septic shock.
Severe sepsis is a common and commonly fatal disease and is essentially an exaggerated inflammatory response. The epidemiology of severe sepsis and septic shock has been difficult to determine because of an inconsistent approach to definitions and diagnosis. ⋯ The Surviving Sepsis Campaign recommends a package of evidence based interventions known as the sepsis resuscitation bundles and the sepsis treatment bundles. The aim is to ensure that eligible patients receive all appropriate treatments in a timely fashion, utilising protocol driven prescriptions.
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End tidal carbon dioxide (ETCO2) monitoring is the non-invasive measurement of exhaled CO2. The Intensive Care Society guidelines include (ETCO2) monitoring as one of the objective standards required for monitoring patients in transport, and the American Heart Association recommends that all intubations must be confirmed by some form of ETCO2 measurement. ⋯ It is non-invasive and easy to apply to breathing circuits. The units now available are compact and rugged, with extended battery operating times, which are ideally suited for prehospital use and should be considered as an essential item for advanced airway management.
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Randomized Controlled Trial
How effective are mental health nurses in A&E departments?
A&E departments are key points of contact for many people with mental health problems. Various models of care have been developed in A&E departments for delivering mental health services, but few have been assessed for effectiveness. The present study aimed to assess the impact of a dedicated A&E psychiatric nurse service on several outcomes relevant to patients and clinicians. ⋯ Psychiatric nurse assessment services have been introduced in many A&E departments, although the evidence base for the effectiveness of this development is not well established. This study presents evidence that psychiatric nurses can provide an accurate assessment and referral service with advantages for patient care.
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We describe the first year of operation of a rural emergency medical retrieval service (EMRS), staffed by emergency medicine and anaesthetic consultants and providing air based retrieval of critically ill and injured patients from general practitioner led community hospitals in rural west Scotland. ⋯ Our data show a high level of acuity among this patient group and a need for advanced medical intervention to ensure safe transfer.
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Comparative Study
Patients either contacting a general practice cooperative or accident and emergency department out of hours: a comparison.
Lack of collaboration between general practice (GP) cooperatives and accident and emergency (A&E) departments and many self referrals may lead to inefficient out-of-hours care. ⋯ The contact frequency of self referrals to the A&E department is much lower than that at the GP cooperative. Care is complementary: the A&E department focuses on trauma while the GP cooperative deals with a wide range of problems. The self referrals concern mostly minor, non-urgent problems and can generally be treated by the general practitioner, by a nurse, or by advice over the telephone, particularly in the case of optimal collaboration in an integrated care facility of GP cooperatives and A&E departments with one access point to medical care for all patients.