Emergency medicine journal : EMJ
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Transfusion thresholds for upper gastrointestinal bleeding (UGIB) are controversial. Observational studies suggest associations between liberal red blood cell (RBC) transfusion and adverse outcome. A recent trial reported increased mortality following liberal transfusion. We delivered a cluster randomised trial to evaluate the feasibility and safety of implementing a restrictive (transfusion when haemoglobin (Hb) <8 g dL) vs liberal (transfusion when Hb <10 g/dL) RBC transfusion policy for UGIB. ⋯ Adherence to both policies was high, resulting in a reduction in RBC transfusion and separation in the degree of anaemia and RBC exposure. There was a trend towards improved safety in the restrictive policy. We have demonstrated that a large-scale cluster randomised trial is feasible and is now warranted to determine the effectiveness of implementing restrictive RBC transfusion for all patients with AUGIB.
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Existing practice in emergency departments (ED) in the UK for managing anticoagulated patients after blunt head trauma is variable and based on limited evidence. We aimed to determine the head injury complication rate within this group of patients and identify risk factors associated with a poor outcome. ⋯ This is the largest cohort of anticoagulated head injury patients ever reported. The head injury complication rate was 6.1% which correlates well with previous findings. INR was not found to be associated with a poor outcome however GCS <13, vomiting and loss of consciousness were identified as significant risk factors for an adverse outcome in anticoagulated patients with a head injury.
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The continuing shortfall of organs for transplantation has led to interest in Maastricht Category II (uncontrolled) Donation after Circulatory Death (DCD) organ donation. As preparation for a proposed pilot, this study aimed to explore the potential of uncontrolled DCD organ donation from patients presenting in cardiac arrest to the emergency department (ED) who are unsuccessfully resuscitated. ⋯ Identifying potential organ donors in the ED who are unsuccessfully resuscitated from cardiac arrest may contribute to reducing the shortfall of organs for transplantation, although numbers are likely to be small. If such a programme was to be introduced during weekday working hours, there may be around four donors a year. However, even one additional donor per year from hospitals across the UK with an ED and a transplantation service would add considerably to the overall organ donation rate.
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Significant numbers of people attend ED either as a direct result of domestic violence and abuse (DVA) or related admissions, for example self-harm (Boyle et al, 2006, Boursnell and Prosser, 2010). However, effective management remains problematic and as Gibbons (2011) has highlighted DVA often goes unreported by ED staff. The recent National Institute of Health and Care Excellence (NICE) (2014) guidance Domestic violence and abuse […] has identified that front line health care professionals will have a pivotal role and responsibility in the management of DVA in the future. The aim of our research therefore was to gather evidence regarding current practice in the recognition and management of DVA within ED in order to develop recommendations for service development through the following questions:How are survivors of DVA currently identified and managed within the ED?What systems can be put into place to maximize recognition and effective support within this context? ⋯ A number of barriers exist including cultural and organizational structures which mediate against effective assessment and support. The recent NICE (2014) guidelines provide a potential platform to transform effective assessment and support for survivors by ED staff. Findings of the study and implications for service and practice development will form the basis of the presentation.
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Paediatric gynaecology can provide challenging and varied consultations in the emergency department setting. Although the first international journal and society were established in the late 1980's, no specific UK guidelines have been published for the care of children and teenagers in this specialty. Moreover, limited published data is available regarding the types of cases presenting at the "front door". This study aimed to investigate the scope of paediatric and adolescent gynaecological problems presenting to the emergency department of a UK children's hospital. ⋯ The study demonstrates the wide variety of paediatric gynaecology cases that present to the emergency department, nearly two thirds of which require ongoing care. This exhibits a need for both national guidance and appropriate training for front line medical staff covering the common gynaecological problems found in children.