European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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To compare the diagnostic value of the Cincinnati Prehospital Stroke Scale, the Face Arm Speech Test, the Los Angeles Prehospital Stroke Screen and the Melbourne Ambulance Stroke Screen for identifying patients with an acute stroke in a prehospital setting in Belgium. ⋯ The results obtained in this study are comparable with earlier investigations. Given the limitations of the study, we could not identify the most adequate stroke scale. History items seem to be less relevant compared with clinical assessment. Further research is needed to determine the most adequate stroke scale.
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We report the case of a 72-year-old lady who presented to our institute with acute pancreatitis. Seven days later, she experienced an acute episode of chest pain associated with the pronounced electrocardiographic changes and elevated cardiac enzymes. Although subsequent coronary angiography was normal, a left ventriculogram demonstrated a marked area of apical akinesia and hyperkinesia of the basal left ventricular walls. We believe this to be the first case of pancreatitis induced takotsubo cardiomyopathy in the international literature.
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According to the WHO, the yearly national consumption of opioids is one indicator of a country's investment on relieving moderate-to-severe pain. We implemented guidelines for treatment of pain in our emergency department (ED) and tracked the major analgesics used in this ED to monitor trends in pain management over a decade. The study was carried out in a Level I trauma center ED. ⋯ Meperidine use did not change. In conclusion, our ED patients are now generally receiving more analgesics than 10 years ago. Electronically stored data on analgesics are accurate and easily accessible for tracking the nature and quantity of prescriptions, but not for correlating their association with patient outcome.
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Clinical Trial
Initial ventilation through laryngeal tube instead of face mask in out-of-hospital cardiopulmonary arrest is effective and safe.
Bag-valve-mask ventilation is recommended as the initial airway management option for paramedics during cardiopulmonary resuscitation, although this technique requires considerable skill and is associated with the risk of stomach insufflation, regurgitation, and aspiration. The present two-phase study investigated the efficacy and safety of the laryngeal tube (LT-D) used by paramedics as the sole technique for ventilation in out-of-hospital cardiac arrest. ⋯ The LT-D is feasible and effective for airway management and ventilation when used by paramedics in out-of-hospital cardiopulmonary resuscitation and can be recommended as the sole technique in such situations.
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The objective of this audit was to evaluate the impact of brief educational intervention on prompt recognition and treatment of pain in the emergency department. The audit was performed on all patients in the emergency department with pain presenting over a 24-h period on three occasions: preintervention, 1-week postintervention and at 4 months. In 151 patients, pain severity scores were mild (24%), moderate (42%), severe (16%) and unknown (18%). ⋯ There was no significant difference in the number of patients treated within 20 min for severe pain (P = 0.076) and within 60 min for moderate pain (P = 0.796) between audits. The likelihood of receiving analgesia within 20 min increased with the patients' pain category (relative risk: 1.8 95% confidence interval: 1.4-2.3). Documentation of pain assessment and the use of pain scores at triage improved after a brief educational intervention but there was no measurable impact on treatment times.