Emergency medicine journal : EMJ
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Paramedic-delivered prehospital critical care is an established concept in a number of emergency medical services around the world and, more recently, has been introduced to the UK. This review identifies and describes the available evidence relating to paramedics who routinely provide prehospital critical care as primary scene response (critical care paramedics, or CCP). ⋯ There is limited evidence to support the concept of paramedic-delivered prehospital critical care. The best available evidence suggests a benefit from prehospital RSI carried out by CCPs in patients with severe traumatic brain injury, but the impact of CCPs remains unclear for many conditions. Further high-quality research in this area would be welcome.
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Review Case Reports
BET 2: transtracheal ultrasound to confirm tracheal intubation in cardiopulmonary arrest.
A shortcut review was carried out to establish whether transtracheal ultrasonography can reliably identify tracheal placement of and endotracheal tube during cardiac arrest. Using the reported searches, 260 papers were found of which one presented the best evidence to answer the clinical question. ⋯ It is concluded that transtracheal ultrasonography may be a supplementary tool for establishing the correct tracheal tube placement in cardiac arrest. Further work is needed.
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Review Case Reports
BET 1: ultrasound for the diagnosis and drainage of suspected peritonsillar abscess.
A shortcut review was carried out to establish whether intraoral ultrasound increased the accuracy of diagnosis and the success of aspiration in adults with suspected peritonsillar abscess (quinsy). Using the reported searches, one paper 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 this best paper are tabulated. It is concluded that emergency physician-performed intraoral ultrasound can reliably diagnose peritonsillar abscess and leads to greater success at aspiration when compared with the traditional landmark technique.
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Comparative Study
Is the case-mix of patients who self-present to ED similar to general practice and other acute-care facilities?
To benchmark walk-in presentations to emergency departments (ED) with those presenting to other local acute healthcare facilities. ⋯ Patients with injuries and possible cardiac chest pain were more likely to attend the ED, and those with infection or musculoskeletal problems less likely, as compared with other acute healthcare facilities. The population presenting to the ED is distinct from that presenting to general practice, out-of-hours clinics, or walk-in centres.
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Comparative Study
Insights on the effects of patient perceptions and awareness on ambulance usage in Karachi, Pakistan.
Prehospital care is a vital part of emergency medical care. Countries with decentralised ambulance systems, such as Pakistan, require patient knowledge as to when to call an ambulance and which service to call. Little is known about how patient perceptions of ambulance services affect ambulance usage in most low- and middle-income countries (LMIC). The purpose of our study was to analyse patient perspectives of the ambulance system in Karachi to understand how to improve ambulance use. ⋯ Insight into the main issues affecting patient decisions to use an ambulance service offers possible targets for patient education that could result in an increase in the proper usage of ambulances and thus optimise outcomes from serious injury and illness in an LMIC context.