Emergency medicine journal : EMJ
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Review
Disaster management in low- and middle-income countries: scoping review of the evidence base.
Globally, there has been an increase in the prevalence and scale of disasters with low- and middle-income countries (LMICs) tending to be more affected. Consequently, disaster risk reduction has been advocated as a global priority. However, the evidence base for disaster management in these settings is unclear. ⋯ Considerably more articles were published from high-income country settings that may reflect a publication bias. Current grey literature on disaster management tends not to be peer reviewed, is not well organised and not easy to access. The paucity of peer-reviewed publications compromises evidence review initiatives that seek to provide an evidence-base for disaster management in LMIC. As such, there is an urgent need for greater research and publication of findings on disaster management issues from these settings.
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Pain management in emergency departments (ED) is often inadequate despite the availability of effective analgesia, with many patients receiving insufficient and untimely analgesia. We conducted a systematic literature review to identify interventions that could improve pain management in the ED. ⋯ Many interventions reported improvements in pain management, but current evidence is insufficient to recommend any for widespread adoption. In order to improve pain management we need to understand more about the theory underlying interventions, the context in which interventions work, and develop interventions based on this stronger theoretical understanding.
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Randomized Controlled Trial
Comparison of intubation modalities in a simulated cardiac arrest with uninterrupted chest compressions.
Interruptions in chest compressions during cardiopulmonary resuscitation can negatively impact survival. Several new endotracheal intubation (ETI) techniques including video laryngoscopy may allow for ETI with minimal or no interruptions in chest compressions. We sought to determine the impact of three different ETI techniques upon time to intubation (TTI) in a simulated cardiac arrest during uninterrupted chest compression. ⋯ In this simulated model of cardiac arrest with uninterrupted chest compressions, TTI was shorter for GVL than DL while use of the GVL with bougie resulted in longer TTI.
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The NHS has seen a great expansion in the number of emergency care practitioners (ECPs) working in prehospital, primary and acute care settings since the role was introduced in 2003. This paper updates and expands on two previous reviews of ECP roles by identifying and discussing all empirical studies to date that examined the impact of ECP services in the NHS. ⋯ Successful implementation of the ECP role has been described. Further evaluations should consider whether the beneficial impact of the role transfers equally across all operational settings and patient groups, and is not just a reflection of new investment in clinical services.
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A short cut review was carried out to establish whether restrictive fluid administration in penetrating thoracic trauma impacted on patients' mortality. 143 papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these are tabulated. It is concluded that there is paucity of relevant research and there is limited scientific evidence to inform fluid administration in these patients.