Emergency medicine journal : EMJ
-
Observational Study
Cerebral oximetry levels during CPR are associated with return of spontaneous circulation following cardiac arrest: an observational study.
Cerebral oximetry using near-infrared spectroscopy measures regional cerebral oxygen saturation (rSO2) non-invasively and may provide information regarding the quality of cerebral oxygen perfusion. We determined whether the level of rSO2 obtained during cardiopulmonary resuscitation is associated with return of spontaneous circulation (ROSC) and survival in Emergency Department (ED) patients presenting with cardiac arrest. ⋯ In ED patients with cardiac arrest higher cerebral oxygen saturations are associated with higher rates of ROSC.
-
Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for extrication or the factors which affect this time. ⋯ This paper describes the development of a tool to predict extrication time for a trapped patient. A number of factors were identified which significantly contributed to the overall extrication time.
-
Mountain Rescue Teams in Snowdonia endeavour to use pelvic splints as per JRCALC guidelines. However, mountain casualties with major mechanisms of injury are often found in precarious locations where application of splints is challenging. We wondered whether the pelvic fractures seen in mountain casualties are of the type likely to benefit from splintage. ⋯ Pelvic fractures are uncommon in Snowdonia mountain casualties, and, in survivors, the vast majority are stable (92%, cf. 55% in urban casualties). Severe pelvic disruption was seen only in casualties declared dead at scene. Only one casualty in a nine-year period had a pelvic fracture that might benefit from a pelvic splint. Our data suggests that application of pelvic splints need not be considered a high priority in mountain casualties, especially in precarious locations.
-
During 2011/12, East Midlands Ambulance Service (EMAS) received 776,000 emergency 999 calls of which 36% (277,000) did not require transportation to hospital. Inappropriate calls can be due to public misunderstanding of when it is appropriate to ring 999. NHS 111 is an alternative free telephone service that enables the public to access health care advice or resources when the matter is urgent but not a 999 emergency. However knowing which service to telephone is not always easy and such a decision can be particularly difficult for older people as symptom presentation across complex co-morbidities can be atypical. A mixed method scoping project was carried out to explore the understanding, use and experiences of emergency (999) and urgent services (NHS 111) by older people aged 65 and over. Here, we report findings from the qualitative workstream. ⋯ Developing a greater understanding of how older people decide to contact a service would support future policy and practice implementation. If the remit of a service is unclear and accompanying publicity confusing, older people will continue to dial 999.
-
We noticed that COPD patients travelling long distances to our rural ED arrived in a worse condition than those living nearby. We suspected this might be due to oxygen-driven nebulisers en route: high-flow oxygen during transfer is known to increase COPD mortality. ⋯ These results support our observation that COPD patients living a long way from hospital are sicker on arrival in ED: but they are sicker to start with. Almost everyone arrives at hospital approximately as sick as they were on ambulance arrival, the exception being a small subgroup living furthest from the hospital (35-40 miles). Our data are retrospective and preliminary: numbers are too small for statistical analysis. However, they suggest that COPD patients in rural areas are already sicker-possibly seeking help later-than those living nearby. A larger study is needed to confirm these results and investigate why: is it rural GPs, their patients, or both, who have a higher threshold for hospital admission than those living closer? Rural PHEM service planners should consider that paramedics in rural areas not only have longer transport times to hospital, but may also be caring for sicker patients than their urban counterparts.