Emergency medicine journal : EMJ
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WHO ETAT training courses provide comprehensive training in paediatric emergency care over 3.5-5 days and have been shown to improve outcome in resource-limited settings. However, the logistics, cost and impact on local service delivery of a five-day course may limit training opportunities in some settings. In this context, we aimed to determine whether a shorter, more focused course would be feasible. ⋯ 'Essential ETAT' was well received by participants and improvements in post-course test scores compared well to results from standard ETAT courses. Further evaluation is required to indicate whether knowledge is retained and changes clinical practice. Focused, short duration resuscitation training may offer a pragmatic and potentially cost-effective alternative to standard courses.
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Traditional management of Clinical Scaphoid Fractures has been to immobilise the wrist for 10-21 days and then reassess the injury. Birmingham Children's Hospital (BCH) has offered an Early MRI service for these patients for 12 years. The aim is to MRI the wrist within a few days of injury to get a definitive diagnosis and reduce unnecessary immobilisation. The objective of this review of the Early MRI service, was to analyse: Age, Sex and Hand dominance Percentage of actual scaphoid fractures & other carpal/radial fractures Time from presentation to MRI scan ⋯ It is possible to offer Early MRI scanning for Clinical Scaphoid Fractures, and most commonly our patients waited 3 days, reducing the length of immobilisation. A large number of other injuries were identified which were missed on initial Xrays. Half of all subjects have a fracture, however only half of these were scaphoid fractures. Only approximately a quarter of scans were normal, and therefore immobilised unnecessarily. Boys are more likely to actually have a scaphoid fracture on MRI than girls.
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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.
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There is currently little evidence defining the clinical importance of detecting and treating isolated distal deep vein thrombosis (IDDVT). Contemporary international guidelines vary regarding diagnostic and therapeutic advice. The potential benefits of anticoagulation remain poorly defined. We sought to evaluate the feasibility of a randomised controlled trial within a modern emergency department cohort. ⋯ We have established feasibility for a definitive trial on the value of therapeutic anticoagulation for IDDVT. Our pilot study currently provides the largest prospective randomised clinical dataset on this topic and demonstrates a non-significant trend towards reduction in complications with anticoagulation.
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Emergency Department information sharing with Community Safety Partnerships and the Police is well established, Emergency Department Data about the location, time of assault and weapon type is shared with the police to support targetted policing and licensing decisions. It is not established whether ambulance data, which routinely collects automated location and time data, provides additional information to police and emergency department data. We aimed to find out what proportion of ambulance call outs to assault was not recorded by the police or the emergency department services. ⋯ The ambulance service is responding to many victims of community violence that are not recorded by the police and probably not recorded by the emergency department. Ambulance data has potential to inform licensing and targetted policing. It is not proven whether this will reduce community violence.