Emergency medicine journal : EMJ
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A short cut review was carried out to establish whether a normal erect chest radiograph excludes the diagnosis of perforated abdominal viscus. Altogether 37 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are shown in table 1. A clinical bottom line is stated.
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Children frequently present to the accident and emergency (A&E) department in pain. Most presentations are acute, but children with pain of longer duration also present. Children also often undergo painful procedures in A&E in the process of diagnosis or treatment. ⋯ Part II: Pharmacological methods of paediatric analgesia. Part III: Non-pharmacological methods of pain control and anxiolysis. Part IV: Paediatric sedation in accident and emergency.
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A short cut review was carried out to establish whether a normal cervical spine radiograph excludes bony cervical spine injury in alert, asymptomatic trauma patients. Altogether 232 papers were found using the reported search, of which six presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are shown in table 2. A clinical bottom line is stated.
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Recent changes in the NHS have seen nurses take on roles that are traditionally filled by doctors, leading to the development of emergency nurse practitioners (ENPs). In addition to this, increasing interest has focused on telemedicine (literally, medicine at a distance) as a way of supporting remote emergency departments and minor injuries units from larger centres. The vast majority of these consultations are related to peripheral limb trauma and require a radiograph to be viewed as an integral part of the telemedical consultation. The aim of this study was therefore to determine whether nurses working alone in a peripheral unit are able to appropriately request, and accurately interpret, peripheral limb radiographs. ⋯ Experienced nurses, working without continuous medical supervision in a remote unit, are able to request appropriate radiographs of the peripheral limbs. Nurses requesting radiographs in this way can also interpret these films to a high standard, though with a tendency to err on the side of caution, generating many more false positive results than false negatives.
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To decrease waiting times within accident and emergency (A&E) departments, various initiatives have been suggested including the use of a separate stream of care for minor injuries ("fast track"). This study aimed to assess whether a separate stream of minor injuries care in a UK A&E department decreases the waiting time, without delaying the care of those with more serious injury. ⋯ The introduction of a separate stream for minor injuries can produce an improvement in the number of trauma patients waiting over an hour of about 30%. If this is associated with an increase in consultant presence on the shop floor it may be possible to achieve a 50% improvement. It is recommended that departments use a separate stream for minor injuries to decrease the number of patients enduring long waits in A&E departments.