European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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To obtain information about patient, staff and organization characteristics of Emergency Departments in the Netherlands, and evaluate the changes between 1996 and 1999. ⋯ Almost all hospitals in the Netherlands reported an increase in the number of patients visiting the Emergency Department, especially in the number of self-referred patients. A majority of the Emergency Departments are now staffed by emergency physicians instead of surgical residents. Developing specific training programmes for emergency physicians should be a priority for the Netherlands in the future.
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Methaemoglobinemia is a disorder in which the haemoglobin molecule is functionally altered and prevented from carrying oxygen. A variety of aetiologies including genetic, dietary, idiopathic and toxicological sources may cause methaemoglobinemia. Symptoms vary from mild headache to coma or death, and may not correlate with measured methaemoglobin concentrations. ⋯ A 23-year-old girl who arrived in the emergency department in a state of confusion with intense cyanosis. The night before she had drunk water with ice defiled by ammonium nitrate, poured from a broken pack of instant ice. The absence of improvement after the administration of oxygen and the 'chocolate brown' colour of the arterial blood gave us the most important clue in suspecting the diagnosis of methaemoglobinemia.
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Comparative Study
The role of the emergency medicine resident using the Alvarado score in the diagnosis of acute appendicitis compared with the general surgery resident.
To compare the accuracy of diagnosing appendicitis between emergency medicine residents using the Alvarado score and general surgery residents using ultrasonography and their clinical provision. ⋯ There was no statistical difference between the emergency medicine residents using the Alvarado score and the general surgery residents in terms of suspecting the diagnosis of appendicitis.
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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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Ambulance paramedics have been practising in North Ayrshire for some time. The aim of this study was to determine the range and number of procedures that are undertaken by paramedics, and whether they are performed in accordance with standard operating procedures. ⋯ Paramedic exposure to extended skills is low in this region, leading to concerns about advanced skills retention. Paramedics can administer drugs appropriately according to protocol. Increasing paramedic experience, possibly augmented by feedback via audit, may be influencing paramedic decision making.