Emergency medicine journal : EMJ
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Review
Near-infrared spectroscopy in the assessment of suspected sepsis in the emergency department.
The conventional approach to sepsis resuscitation involves early interventions targeting global oxygenation and macro-haemodynamic variables such as central venous and systemic arterial pressures. There is increasing recognition of the importance of microcirculatory changes in shock states, including sepsis, and the relationship of these to outcome. Near-infrared spectroscopy (NIRS) is a recently developed non-invasive technology that measures tissue oxygen saturations (StO2), which may be an indirect measure of the adequacy of the microcirculation. StO2 measurements, therefore, have the potential to identify patients who are at risk of progressing to organ dysfunction and could be used to guide resuscitation. This article reviews the current state of knowledge of NIRS in the setting of sepsis, examining its application, validity and prognostic value. ⋯ Outstanding questions still remain as to whether NIRS can help to risk-stratify patients with suspected sepsis in the emergency department and the utility of StO2 as a resuscitation target.
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To understand whether aviation-derived human factors training is acceptable and useful to healthcare professionals. To understand whether and how healthcare professionals have been able to implement human factors approaches to patient safety in their own area of clinical practice. ⋯ In order to successfully apply human factors approaches in hospital, careful consideration needs to be given to the local context and informal culture of clinical practice.
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Observational Study
Diagnostic accuracy of lateral neck radiography in ruling out supraglottitis: a prospective observational study.
To assess the diagnostic accuracy of lateral neck radiographs (LNR) for acute supraglottitis in adults. ⋯ LNR showed only moderate sensitivity and specificity for supraglottitis and would miss some cases of supraglottitis if the pre-test probability is high. LNR was very sensitive for grade 3 or higher supraglottitis, but would miss milder cases.
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To investigate the performance characteristics in children with moderate and minor injuries of prehospital paediatric triage tools currently in use in England for identifying seriously injured children. ⋯ Three tools (East Midlands, North West and Northern) demonstrated acceptable over- and under-triage rates in this population of minor and moderately injured children. All tools reached recommended standards for over-triage, but the majority favoured under-triage.
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If package counts on abdominal CTs of body-packers were known to be accurate, follow-up CTs could be avoided. The objective was to determine the accuracy of CT for the number of concealed packages in body-packers, and the reliability of package counts reported by body-packers who admit to concealing drugs. ⋯ The accuracy of CT for determining the number of concealed packages is poor, although when applied to patients with few concealed packages accuracy is high and is useful as a rule-out test. Among patients who have admitted to drug concealment, the number of packages reported to be concealed is reliable.