Emergency medicine journal : EMJ
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Multicenter Study Observational Study
Long-term prognosis after out-of-hospital resuscitation of cardiac arrest in trauma patients: prehospital trauma-associated cardiac arrest.
Although prehospital cardiac arrest (CA) remains associated with poor long-term outcome, recent studies show an improvement in the survival rate after prehospital trauma associated CA (TCA). However, data on the long-term neurological outcome of TCA, particularly from physician-staffed Emergency Medical Service (EMS), are scarce, and results reported have been inconsistent. The objective of this pilot study was to evaluate the long-term outcome of patients admitted to several trauma centres after a TCA. ⋯ Among patients admitted to hospital after successful CPR from TCA, hypoxia as the likely aetiology of arrest carried a more favourable prognosis. Most of the patients successfully resuscitated from TCA and surviving to hospital discharge had a good neurological outcome, suggesting that prehospital resuscitation may not be futile.
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The prehospital termination of resuscitation (TOR) guidelines for traumatic cardiopulmonary arrest (TCPA) was proposed in 2003. Its multiple descriptors of cases where efforts can be terminated make it complex to apply in the field. Here we proposed a simplified rule and evaluated its predictive performance. ⋯ The simplified TOR rule appears to accurately predict non-survivors in adults with TCPA in the prehospital setting.
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Clean catch urine (CCU) collection in precontinent children is often time-consuming, with associated collection failure. We hypothesise that stimulating cutaneous reflexes hastens voiding for CCU. ⋯ Quick-Wee appears to be a simple method to speed CCU in young children.
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Musculoskeletal trauma to the foot is a common presentation to EDs. A Lisfranc fracture dislocation involves injury to the bony and soft tissue structures of the tarsometatarsal joint. While it is most commonly seen post high velocity trauma, it can also present post minor trauma. ⋯ Once diagnosed, Lisfranc injuries can be classified as stable or unstable. Stable injuries can be immobilised in EDs and discharged home. Unstable injuries require an orthopaedic referral for consideration of surgical fixation.
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A short cut review was carried out to establish whether a vagal manoeuvre was better than or as good as adenosine at safely terminating supraventricular tachycardia in children. Forty unique papers were found in Medline and Embase using the reported searches, of which five were relevant. A hand search of the forty unique citations identified a further nine relevant papers. ⋯ This best evidence shows that ice water to the face appears to be a safe, quick, effective and non-invasive treatment for paediatric SVT. Adenosine also appears safe and effective, but is more invasive. Valsalva and carotid sinus massage are less effective.