The journal of the Royal College of Physicians of Edinburgh
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J R Coll Physicians Edinb · Jun 2010
Mortality in out-of-hours emergency medical admissions--more than just a weekend effect.
Mortality among emergency medical admissions to hospital is higher for admissions at the weekend than on weekdays; this also holds true for certain specific conditions. However, it is unknown whether that effect is limited to weekends. ⋯ Total mortality was increased for admissions on Mondays, at night, and in all out-of-hours periods; late in-hospital mortality (after seven days) remained increased when the initial admission occurred on Mondays, at night or out of hours. It is likely that illness severity as well as resource and organisational factors are involved.
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Anaphylaxis is the quintessential medical emergency where prompt recognition and treatment is life-saving. In the UK the incidence is increasing year on year, and is most common in the sixth and seventh decades of life. More than half of cases are iatrogenic in nature, most of the rest are caused by venom (stings) and food substances. ⋯ Any delay in treatment is associated with increased risk of adverse outcome. Steroids and antihistamines are often given, although there is no convincing evidence of their effect in the acute setting. Where diagnostic uncertainty arises, serum tryptase levels can confirm or refute the diagnosis.
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J R Coll Physicians Edinb · Mar 2010
Review Comparative StudyUpdate on cardiopulmonary resuscitation.
Adult cardiopulmonary resuscitation (CPR) has been shown to improve survival for individuals suffering cardiac arrest. Despite this, the delivery of basic life support to victims outside the clinical environment remains poor, particularly as only a minority receive resuscitation. In addition, research continues to examine the optimal techniques for CPR and guidelines have been modified to reflect the latest developments. ⋯ Throughout the guidelines a more pragmatic approach to resuscitation is adopted to try to encourage all individuals, whether trained healthcare professionals or lay people, to initiate resuscitation. An acknowledgement of the reasons why individuals may be reluctant to start resuscitation through fear or anxiety will hopefully help to encourage the instigation of these techniques. This overview will summarise the guidelines and highlight alterations or alternatives where appropriate.