Emergency medicine journal : EMJ
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To measure the possible delays in intravenous nitroglycerine administration. ⋯ Despite limitations, this study outlines the importance of cannula type, infusion accessories and carrier lines. Larger cannulae and greater priming volumes substantially delay drug delivery, whereas carrier lines/drive lines substantially accelerate drug delivery. Our study also shows how patients could be exposed to clinical delays, as well as incorrect presumptions about drug dosage. Guidelines, and education efforts, should highlight the clinical importance of factors that affect bag-to-bloodstream time.
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Some ambulance services in the UK use the Medical Priority Dispatch System (MPDS) to triage 999 calls and determine the response allocated to patients. When MPDS was developed in the 1970s Sickle Cell Disease (SCD) was not common in the UK and was therefore not included in the system. As ethnic diversity in the UK increased so did the prevalence of SCD, yet ambulance services were still unable to identify this group of patients and assess their specific needs. Patients with SCD usually contact the ambulance service when they experience a Sickle Cell Crisis (SCC), which is characterised by severe pain. It is important ambulances arrive quickly to allow patients' pain to be managed in a timely manner. However, not having a way to identify these patients at the time of the 999 call means that patients potentially receives variable responses. ⋯ The over-ride resulted in a quicker ambulance response which reduced the chances of the patient's condition worsening before the arrival of an ambulance. This project also provided evidence and allowed for the SCC override to be adopted nationally.
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Care for older people with dementia (OPWD) is a major concern across all care settings. Ambulance services are in the spotlight as pressures on emergency services and calls for admission avoidance are policy priorities. Around 1/3 of emergency call-outs are to people 75 and over, a significant proportion of whom may have dementia. There is a perception that dementia may be an issue but we do not understand how much this affects use of emergency services. ⋯ There is little current research that understands what ambulance clinicians are doing with respect to caring for OPWD. Research questions should focus on how communication between the person with dementia, formal/informal carers, healthcare professionals and emergency services affects the care provided for older people with dementia during and immediately after urgent care events.
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Intraosseous access (IO) is becoming increasingly accepted in adult populations as an alternative to peripheral vascular access; however, there is still insufficient evidence in large patient groups supporting its use. ⋯ IO access can be used to administer a wide variety of life-saving medications quickly, easily and with low-complication rates. This highlights its valuable role as an alternative method of obtaining vascular access, vital when resuscitating the critically injured trauma patient.