Emergency medicine journal : EMJ
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The use of therapeutic hypothermia is recommended for unconscious adult patients with return of spontaneous circulation (ROSC) after out-of-hospital ventricular fibrillation cardiac arrest. There is evidence that the time taken to achieve target temperature impacts survival. ⋯ Among OHCA patients who met recognised inclusion criteria, therapeutic hypothermia was implemented successfully by the ED staff. The temperature should be measured continuously from the same site in both the ED and the ICU. This will provide consistent and continuous temperature monitoring between the ED and the ICU and will enable prompt intervention to prevent temperature increases.
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Cranial CT (CCT) is the gold standard to rule out traumatic brain injury. The serum level of the protein S-100B has recently been proposed as promising marker of traumatic brain injury. We prospectively investigated whether it might be a reliable tool for CCT triage in mild brain injury at a peripheral trauma centre with limited CT resources. ⋯ The S-100B serum level showed a high sensitivity and negative predictive value in the screening of patients with mild head injury. The use of serum S-100B as a biomarker for CCT triage may improve patient screening and decrease the number of CCT scans performed. This would reduce unnecessary radiation exposure and free up capacity in the emergency rooms of peripheral hospitals to enable them to cope better with multiple admissions.
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Direct current cardioversion (DCC) has been shown to be effective for the management of atrial fibrillation (AF) in the emergency department (ED). Pharmacological cardioversion was compared with a strategy including DCC on patients with uncomplicated, recent-onset (<48 h) AF managed in a short observation unit (SOU). ⋯ Electrical cardioversion of recent-onset AF in the SOU is safe, effective and reduces hospitalisations. Further studies are needed to identify the most cost-effective strategy for the management of AF patients in emergency settings.
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To determine which measures, other than a reduction in waiting time, could prevent the departure of the left-without-being-seen (LWBS) patients in an emergency department. Secondary objectives were description of the characteristics of LWBS patients, analysis of their reasons for leaving and assessment of their medical outcome. ⋯ The 'quality' of the waiting time appears to be important in the decision to leave. If this aspect was taken into account, a reduction in the number of LWBS patients and improved quality of care could be achieved in emergency departments.
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A traumatic abdominal wall hernia (TAWH) caused by a handlebar collision is very rare. It is difficult for the emergency physician to exclude the possibility of mesenteric or intestinal injuries when viewing handlebar trauma. ⋯ An unusual case of TAWH caused by a handlebar injury is reported, where a multi-layer muscular defect was found along with a segment of incarcerated jejunum and omentum. The latest literature is reviewed, and valuable ideas on the management of blunt abdominal trauma with TAWH are shared.