European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study
Intubation and survival in severe paediatric blunt head injury.
The majority of severe childhood injuries are due to head injuries. We studied the impact of emergency intubation in a cohort of children suffering severe blunt head trauma. A 10-year retrospective case note analysis was performed on 176 children (age < 16 years) with severe blunt head trauma (abbreviated injury scale > or =4) in Southern Finland, who required intensive care in a level 1 trauma centre, or who died despite initiation of life supporting measures at the scene. ⋯ Children intubated at the scene or in the ER of regional hospitals, had significantly worse AIS (head/neck), injury severity score (ISS), and Glasgow coma (GCS) scores than those children intubated in the ER of the level 1 trauma centre. Survival was better in field-intubated children compared with those intubated in regional hospital ERs, despite similar trauma scores (p = 0.05). It is concluded that although children with severe (AIS > or =4) head injury who require emergency intubation have a high overall mortality, field-intubation may improve survival, compared with 'scoop and run' with BLS airway management and deferred emergency intubation.
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Effective strategies for the aetiologic diagnosis in patients with ischaemic stroke can be implemented based on simple clinical criteria and instrumental tests which can be performed in a modern emergency room (ER) within 24 hours from admission. This may bear prognostic and therapeutic relevance for patients with acute stroke. Therefore, in this study we set out to establish the feasibility and accuracy of the aetiologic diagnosis of ischaemic stroke in an ER. ⋯ Stroke of undetermined origin represented one-third of patients in a consecutive population with acute onset neurologic deficit of ischaemic origin. In approximately half of the patients with negative standard evaluation, cardiogenic or aortic arch embolic sources could be identified by transoesophageal echocardiography. Thus, the latter is indicated in patients with stroke of undetermined origin with negative first-line evaluation in order to identify embolic sources in the aortic arch.
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The 'three in one' block is a well-known locoregional technique for per- and post-operative anaesthesia. This 'three in one' block was investigated in an emergency department with three combinations of local anaesthetics as a locoregional way of pain relief for patients with fractures of the upper femur. A double-blind prospective study was conducted with 61 consecutive patients. ⋯ The technique failed in only four patients due to technical reasons. It was concluded that the 'three in one' block is a fast, safe, reliable and easy technique for pain relief in an emergency department. Good analgesia was achieved for patients with fractures of the upper femur with no need to change the position of the patient.
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This is a report on our first 2 years' experience of operating a helicopter emergency medical service in the Canary Islands, Spain. The two advanced life-support helicopters are staffed full time by a physician and a nurse. For the transport protocol, inter-hospital transport patients (secondary missions) were classified into three groups: group A, minor illnesses or injuries; group B, modified or middle critical condition; and group C, critical condition. ⋯ The cost per mission was US$2300. In the interests of safety and rationalization of the use of resources, transport of non-critical patients should be reduced. The presence of a trained physician and nursing crew and stabilization before transport could be responsible for the low mortality rate.
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Does witnessed cardiopulmonary resuscitation alter perceived stress in accident and emergency staff?
The aim of this study was to ascertain if the presence of patients' relatives during cardiopulmonary resuscitation altered perceived symptoms of stress in accident and emergency personnel participating in resuscitation attempts. An anonymous structured questionnaire survey of all accident and emergency staff participating in non-traumatic adult cardiopulmonary resuscitation was designed to elicit symptoms of an acute stress reaction within 24 hours based on ICD-10 diagnostic criteria. One hundred and fourteen staff replies were received, a reply rate of 89%. ⋯ The grade or role of the staff member had no influence on the presence of stress symptoms. There was no difference in rates of reporting between staff resuscitating in the presence or absence of relatives. It is concluded that the presence of relatives witnessing resuscitation attempts does not affect self-reported stress symptoms in staff participating in resuscitation attempts.