Emergency medicine journal : EMJ
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The practice of triage was conceived during the Napoleonic wars, with the aim of salvaging those soldiers whose injuries were readily treatable, returning them to the battlefield at the earliest opportunity. Literally, the word triage means "to sieve" or "to sort" (French trier), and those earlier battlefield principles have been refined and expanded to now encompass trauma and medical emergencies, with triage practiced in prehospital and hospital settings. To address the anatomical, physiological and developmental differences encountered when dealing with children, specific paediatric triage systems have also been developed, and this article discusses their merits.
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Multicenter Study Comparative Study
An evaluation of an educational intervention to reduce inappropriate cannulation and improve cannulation technique by paramedics.
Intravenous cannulation enables administration of fluids or drugs by paramedics in prehospital settings. Inappropriate use and poor technique carry risks for patients, including pain and infection. We aimed to investigate the effect of an educational intervention designed to reduce the rate of inappropriate cannulation and to improve cannulation technique. ⋯ The educational intervention was effective in bringing about changes leading to enhanced quality and safety in some aspects of prehospital cannulation.
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To improve the care of patients presenting to the emergency department who are acutely dying or those in whom further disease-modifying treatment is not appropriate. ⋯ It has been a rewarding undertaking to improve the care of dying patients, but one which has taken time and has required consistent management of change to promote the positive outcomes.
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Case Reports
Bullet embolisation from the right subclavian vein to the right ventricle: a case report.
Bullet embolism to the heart is an unusual complication of penetrating gunshot injuries. A bullet may reach the heart by direct cardiac penetration or entry into the peripheral venous system with embolisation to the heart, which must be differentiated. This is a report of an unusual case of bullet embolism to the heart that was extracted by direct cardiotomy without cardiopulmonary bypass.
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Chemical burns of the eye represent 7.0%-9.9% of all ocular trauma. Initial management of ocular chemical injuries is irrigation of the eye and conjunctival sac until neutralisation of the tear surface pH is achieved. We present a case of alkali injury in which the raised tear film pH seemed to be unresponsive to irrigation treatment. ⋯ Use of faulty or inappropriate materials can also result in errors. We advocate the use of control litmus pH test in all patients. This would highlight errors in pH measurements and aid in the detection of the end point of irrigation.