Emergency medicine journal : EMJ
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Comparative Study
Ambulance call triage outcomes for patients reporting pain: a retrospective cross-sectional analysis of pain score versus triage level.
To identify any association between the response priority code generated during calls to the ambulance communication centre and patient reports of pain severity. ⋯ The severity of pain experienced by the patient appeared to have no influence on the priority (urgency) of the dispatch response. Triage systems used to prioritise ambulance calls and decide the urgency of response or type of referral options should consider pain severity to facilitate timely and humane care.
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Non-traumatic undifferentiated hypotension is a common critical presentation in the emergency department. In this group of patients, early diagnosis and goal-directed therapy is essential for an optimal outcome. The usefulness of focused bedside ultrasound is reviewed and a protocol for Abdominal and Cardiac Evaluation with Sonography in Shock (ACES) is proposed. ⋯ The six-view ACES protocol is a useful adjunct to clinical examination in patients with undifferentiated hypotension in the emergency department. A prospective randomised trial or multicentre database/registry is needed to investigate the validity and impact of this protocol on the early diagnosis and management of hypotensive patients.
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Point-of-care echocardiography using portable machines is an exciting development in emergency medicine. Recent improvements in ultrasound quality mean that emergency physicians are finding echocardiography useful in a variety of clinical settings. ⋯ Patients with clinical conditions such as breathlessness, undifferentiated shock, chest pain and cardiac arrest may benefit. There is a steep learning curve involved in acquiring these skills and the specialty needs to take care in the way that its practitioners are accredited and perform echocardiography.
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Multicenter Study
Coma and impaired consciousness in the emergency room: characteristics of poisoning versus other causes.
Unconscious patients represent a diagnostic challenge in the emergency room (ER), but studies on their characteristics are limited. The aim of this study was to investigate the frequency, characteristics and prognosis of different coma aetiologies with special focus on poisoning. ⋯ Poisoning was the most common cause of coma and young age was a strong predictor of this condition. The prognosis was favourable among poisoned patients but poor in the rest of the study population as a group.
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Multicenter Study
Influence of air ambulance doctors on on-scene times, clinical interventions, decision-making and independent paramedic practice.
Critics of air ambulance doctors question their contribution and believe on-scene time is prolonged. Two helicopter emergency medical service (HEMS) models operate in the West Midlands, one with doctors and the other without. A study was undertaken to compare on-scene time, management and decision-making between the two units. ⋯ Appropriately trained HEMS doctors provide advanced management and decision-making. This is without a negative effect on on-scene time, even when performing complex procedures. They are more likely to declare death or discharge patients at the scene, increasing the availability of this limited resource.