Emergency medicine journal : EMJ
-
Observational Study
Comparison of outcomes in patients with head trauma, taking preinjury antithrombotic agents.
This study compares clinical outcomes in patients with head trauma, taking preinjury antiplatelet drugs (aspirin, clopidogrel) and anticoagulants (warfarin). ⋯ A high proportion of patients taking warfarin underwent neuroimaging, but brain injury and admission rates were comparable between groups. There were no significant differences in short-term outcomes between the groups. The overall mortality is higher for patients on antiplatelet agents than warfarin.
-
In endotracheal intubation, a secured airway includes an insufflated cuff distal to the vocal cords. High cuff pressures may lead to major complications occurring after a short period of time. Cuff pressures are not routinely checked after intubation in the prehospital setting, dealing with a vulnerable group of patients. ⋯ Initial cuff pressures are almost all too high, needing adjustment to be in the safe zone. Dutch paramedics lack manometers and, therefore, only few paramedic intubations are followed by cuff pressure measurements. We recommend cuff pressure measurements after all (prehospital) intubations and, therefore, all ambulances need to be equipped with cuff manometers.
-
How much does alcohol contribute to the demands on the Emergency Department (ED)? York is a popular tourist destination, particularly amongst hen and stag parties. But a quarter of the resident population have previously been identified as higher risk drinkers. So therefore, how much does alcohol contribute to the pressures on York ED? Additionally, clinical coding of alcohol within the ED is anecdotally unreliable. How true is this? We therefore undertook an alcohol needs assessment within York ED looking at general demographics, reasons for attendance and evidence of alcohol linked to the attendance. We also looked at the discrepancy between how much the ED was paid for these patients by commissioners and the actual cost to the acute trust. ⋯ The 4 randomly selected weeks amounted to a 5,704 patient sample, 7.2% of the total number of attendances in 2011. 9.8% of attendances were alcohol-related (553 patients) Between 21:00 and 09:00, this rose to 19.7% Alcohol was involved in 45% of mental health attendances The alcohol group was heavily over-represented in the patients removed by police (100%), refusing treatment (55%) and leaving prior to their treatment (41%) 10.3% of alcohol-related attendees remained in the ED for >4hours compared with 5.9% of non-alcohol-related attendees 62.8% of alcohol-related attendees were living within the City of York 18% of all ambulance journeys were due to alcohol Although 553 patients had evidence of alcohol in their attendance, it was only coded as such in 46 computer records If these figures are extrapolated to cover the annual patient population, the discrepancy between what the commissioners pay and the true cost of these patients is £552,431 CONCLUSION: Alcohol poses a disproportionate burden on York Emergency Department and Yorkshire Ambulance Service. With pressures on staffing, the 4 hour standard and ambulance turnaround times at an all-time high, how different would the ED be if the alcohol burden were reduced? This needs assessment fuels the argument for an 'invest to save' attitude to reduce alcohol-related attendance.
-
Understanding the cause of patients' symptoms usually involves identification of a pathological diagnosis. Anecdotal reports suggest that emergency department (ED) providers do not prioritise giving pathological diagnoses, and often reiterate the patient's symptom as the discharge 'diagnosis'. Our pilot study sought to identify the proportion of patients at a large teaching hospital who receive a symptomatic versus pathological diagnosis at ED discharge. ⋯ According to our pilot study, most patients are discharged from the ED without a pathological diagnosis that explains the likely cause of their symptoms. Future studies will investigate whether this finding is consistent across institutions, and whether provision of a pathological diagnosis affects clinical outcomes and patient satisfaction.
-
The role of ambulance clinicians in providing psychosocial care in major incidents and emergencies is recognised in recent Department of Health guidance. The study described in this paper identified NHS professional first responders' needs for education about survivors' psychosocial responses, training in psychosocial skills, and continuing support. ⋯ Ambulance clinicians recognise their own education needs and the importance of their being offered psychosocial training and support. The authors recommend that, in order to meet patients' psychosocial needs effectively, ambulance clinicians are provided with education and training in a number of skills and their own psychosocial support should be enhanced.