Emergency medicine journal : EMJ
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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.
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Comparative Study
Assessment of the impact on time to complete medical record using an electronic medical record versus a paper record on emergency department patients: a study.
Electronic medical records are becoming an integral part of healthcare delivery. ⋯ This is the first study that we are aware of which compared paper versus electronic medical records in the emergency department. Electronic recording took longer than paper records. Physicians were not satisfied using this electronic record. Given the time pressures on emergency physicians, a solution to minimise the charting time using electronic medical records must be found before widespread uptake of electronic charting will be possible.
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Comparative Study Observational Study
Capillary refill time is a predictor of short-term mortality for adult patients admitted to a medical department: an observational cohort study.
Capillary refill time (CRT) has been advocated as a tool for rapid assessment of circulatory status. The correlation between neither CRT and mortality nor CRT and markers of circulatory status has been assessed. We performed a prospective observational cohort study to assess the relationship between CRT (using two existing definitions and as a continuous variable) and short-term mortality. ⋯ We found a significant association between CRT measured as a continuous variable and short-term mortality. Using the definition of Schriger and Baraff also seems appropriate, but this is based on calculations of limited power.
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Comparative Study
Emergency department management of early sepsis: a national survey of emergency medicine and intensive care consultants.
Early goal-directed therapy (EGDT) is recommended for sepsis management in current guidelines, but the underpinning evidence is controversial. Clinician beliefs and the capacity to implement all recommended elements of EGDT in emergency departments (EDs) are uncertain. Our study aimed to explore self-reported management of early sepsis by Scottish emergency medicine (EM) and intensive care medicine (ICM) consultants, delineate important differences and determine the guideline recommendations rated most important and deliverable within the ED. ⋯ Differences in early fluid and vasopressor management of sepsis exist between Scottish ICM and EM consultants. Transfusion practice is highly variable, suggesting clinical uncertainty. Lactate is considered more important than ScVO2 measurement.