Emergency medicine journal : EMJ
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This study, conducted over two time periods, aimed to evaluate the effectiveness of the diffusion of data, implementation of correctives measures and updated protocols in reducing time to reperfusion in acute myocardial infarction (AMI) management in the out-of-hospital setting. Mean (SD) time to hospital admission and to arterial puncture improved (58 (13) vs 67 (18) min, p = 0.03; and 82 (16) vs 95 (29) min, p = 0.02). The study, performed according to quality control programme methodology, showed that the chronology of AMI management could be improved by appropriate interventions and monitoring of intervention times.
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A 32-year-old woman without a remarkable history presented at the emergency department with strangulation of the neck. CT scans of the neck revealed a displaced cricoid fracture. ⋯ The traditional treatment guidelines for laryngeal trauma have recommended an early surgical intervention after immediate tracheotomy in cases of displaced fractures of the cricoid cartilage. The patient could be treated successfully through continuous monitoring of airway obstruction without surgical management.
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Eclampsia is an uncommon and serious condition, particularly in the pre-hospital setting. Immediate treatment is required and should include airway control, administration of oxygen, anti-epileptics and magnesium, hypertension control, and urgent delivery of the baby.
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Randomized Controlled Trial Multicenter Study
Structure, process and outcomes of chest pain units established in the ESCAPE trial.
Chest pain units (CPUs) provide a system of care for patients with acute chest pain that can improve outcomes while reducing health service costs. The Effectiveness and Safety of Chest Pain Assessment to Prevent Emergency Admissions (ESCAPE) multicentre trial was undertaken to determine whether CPUs could be successfully established throughout the National Health Service (NHS). ⋯ CPU care can be instituted in a safe manner at a variety of NHS hospitals, with most patients being discharged after assessment. However, there is variation in the number and type of patients managed by the different units. Further research is required to identify reasons for variation in CPU activity.
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A short cut review was carried out to establish whether patients with deep vein thrombosis (DVT) are at risk of embolism during ultrasound compression testing. No papers were found that directly answered the clinical question. The clinical bottom line is that currently there is no evidence to suggest that compressing vessels in order to identify a DVT could cause an embolic event. Therefore we can consider ultrasound assessment a safe reliable investigation for the diagnosis of DVT with no evidence of causing harm.