European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Multicenter Study Comparative Study
Upper gastrointestinal haemorrhage in Emergency Departments in France: causes and management.
Little is known about the epidemiology of acute upper gastrointestinal haemorrhage hospitalized in Emergency Departments. Most of the studies concerning digestive bleeding have been carried out by Gastroenterology Departments. This multicentre study included consecutive patients with acute upper gastrointestinal haemorrhage hospitalized after an initial management at Emergency Departments in France, to describe the initial medical management and to determine the causes of acute upper gastrointestinal haemorrhage. We also studied the relationship between the use of non-steroidal anti-inflammatory drugs or aspirin and the occurrence of an acute upper gastrointestinal haemorrhage by a case-control comparison. ⋯ Hospitalized acute upper gastrointestinal haemorrhage in Emergency Departments in France is more often caused by cirrhosis than in other countries. Decreasing the delay between the first signs of bleeding and arrival at the Emergency Department is the main challenge in the management of acute upper gastrointestinal haemorrhage.
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To determine the patient factors influencing UK Emergency Department doctors' assessment of suicide risk. To establish whether immediate clinical management is consistent with perceived risk. ⋯ In contrast to the negative findings of previous research, we found that Emergency Department doctors were influenced by key risk factors for suicide in their assessment of deliberate self-harm patients. Emergency Department doctors' assessments reflected the immediate risk of suicide, indicated by factors such as current mental state and strong suicidal intent. Background risk factors such as social adversity and psychiatric history were less influential. We would recommend that training for emergency doctors should emphasize the importance of both immediate and background risk factors.
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The relatively simple technique of administering a femoral nerve block is known to be quick, safe and effective in providing prolonged analgesia to children with femoral shaft fracture. Although medical literature supports its use in the emergency setting, no studies have been conducted on how this is undertaken in practice. ⋯ There is unnecessary delay in carrying out this procedure for children with fractures to the femoral shaft. A significant degree of reliance on staff external to the Emergency Department was reported. This paper supports increased training and supervision to promote the more widespread and prompt use of femoral nerve blocks as an important standard of care for the Emergency Department.
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To compare patient, guardian and professional assessment of acute pain in children presenting to an Emergency Department, and to examine whether there was a correlation between the scores obtained using the Faces and linear scales for each group. ⋯ Professionals score pain lower than do children or guardians. Similar pain scores are obtained using both a Faces and a linear scale. This study offers no support for the introduction of a uniform pain assessment tool in a paediatric Emergency Department setting.
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To define the differences in emergency room usage patterns between patients with and without medical insurance coverage. ⋯ Uninsured patients arrived more frequently during weekends and at night than insured patients. They were on average less likely to be admitted to the hospital. Demographic differences between both groups seemed to play an important role in the admission rate. Despite differences in emergency room usage patterns, it cannot be concluded that either group used the emergency room in excess of the other.