Emergency medicine journal : EMJ
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To evaluate the role of ambulance response times in improving survival for out-of-hospital cardiac arrest (OHCA). ⋯ The arrival of a crew prior to OHCA means that the chance of surviving the arrest increases sevenfold. Overall it is possible that rapid response to patients in immediate risk of arrest may be at least as beneficial as rapid response to those who have arrested. Concentrating resources on reducing response times across the board to improve survival for those patients already in arrest is unlikely to be a cost-effective option to the U.K. National Health Service.
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Multicenter Study
Impact of the Surviving Sepsis Campaign on the recognition and management of severe sepsis in the emergency department: are we failing?
Severe sepsis/septic shock (SS/SS) has a high mortality. The past decade lays witness to a concerted international effort to tackle this problem through the Surviving Sepsis Campaign (SSC). However, bundle delivery remains problematic. In 2009, the College of Emergency Medicine (CEM) set out guidelines for the management of SS/SS. These set the standards for this audit. ⋯ The SSC has had some impact; however, there is still a long way to go. It is assumed that the picture is similar in EDs across the UK and recommendations are made based on these local findings.
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Comparative Study
Bedside ultrasonography for the detection of small bowel obstruction in the emergency department.
Plain film radiography (x-ray) is often the initial study in patients with suspected small bowel obstruction (SBO) to expedite patient care. ⋯ EP-performed US compares favourably to x-ray in the diagnosis of SBO.
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A short-cut review was performed to evaluate whether inflammatory markers such as C reactive protein (CRP), erythrocyte sedimentation rate (ESR), white cell count (WCC) and procalcitonin (PCT) are able to discriminate between streptococcal and viral tonsillitis, enabling a reduction in the overuse of antibiotics. Eight studies with a total of 1031 participants were found. ⋯ The clinical bottom line is that WCC, CRP and PCT levels are higher in patients with streptococcal tonsillitis compared to patients with tonsillitis or pharyngitis without group A streptococcus isolated from a throat swab. Which of these markers has the best test performance characteristics requires further study.