Emergency medicine journal : EMJ
-
Observational Study
Location of arrest and effect of prehospital advanced airway management after emergency medical service-witnessed out-of-hospital cardiac arrest: nationwide observational study.
What is this?
This Korean study investigated 6,620 out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical providers, covering a four year period of the Korean OHCA registry. They looked at outcome among those receiving advanced airway intervention, comparing arrest at scene to arrest in the ambulance.
Why is this interesting?
Past studies have suggested better OHCA outcomes when a supraglottic airway (SGA) is used rather than endotrachial intubation (ETI). We also know that repeated advanced airway attempts are detrimental, and that airway intervention can interrupt CPR.
What was not known is:
- Whether SGA placement is detrimental or beneficial, compared with basic airway support, and;
- Whether there is any difference if the arrest occurs at the scene or in the confines of an ambulance.
And they found:
There was no benefit from advanced airway intervention (SGA or ETI) for EMS witnessed out-of-hospital arrest – and in fact there was an associated worse neurological outcome for in-ambulance OHCA when the airway was instrumented compared to any other group.
Don’t be hasty...
Although the authors reasonably describe the ways in which providing advanced airway interventions in the confines of an ambulance may impede other resuscitation, thus worsening outcomes, it may also be that a patient who still arrests despite receiving EMS care in the back of an ambulance is by definition at risk of worse outcomes despite medical care.
Nevertheless, at worst this retrospective observational study suggests there is no benefit of advanced airways in OHCA.
Bonus...
The authors also provide an interesting overview of the Korean emergency medical system, servicing 50 million people in urban and rural areas. This is an enlightening insight into how one country has structured its EMS service.
summary -
Observational Study
Why are people increasingly attending the emergency department? A study of the French healthcare system.
It is often asserted that the crowding phenomenon in emergency departments (ED) can be explained by an increase in visits considered as non-urgent. The aim of our study was to quantify the increase in ED visit rates and to determine whether this increase was explained by non-severe visit types. ⋯ It appears that the increase in ED use is not based on an increase in non-severe visit types, with a greater impact of intermediate-severity visit types requiring diagnostic or therapeutic procedures in ED.
-
Trauma team activation criteria have a variable performance in the paediatric population. We aimed to identify predictors for high-level resource utilisation during trauma resuscitation in the ED. ⋯ As utilisation of high-level resources in paediatric trauma was rare, it was difficult to find an appropriate balance between under-triage and over-triage. Between the two, minimising the proportion of under-triage is more important as patient safety is paramount in paediatric trauma care.
-
Dental emergencies are common reasons for presenting to hospital emergency departments. Here, we discuss the panoramic radiograph (orthopantomogram (OPG, OPT) as a diagnostic tool for the assessment of mandibular trauma and odontogenic infections. ⋯ The aim is to equip the emergency physician with the skills to use the OPG radiograph when available, and to rapidly assess the image to expedite patient management. Included is a discussion of a number of cases seen in the emergency setting and some common errors in diagnosis.