European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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To determine whether vital signs in patients suffering from acute pain in the out-of-hospital setting have any association with pain severity measured using an ordinal pain scale. ⋯ An association between prehospital vital signs and pain severity has been shown using ordinal logistic regression. In adults, a respiratory rate of 25 breaths/min or more was the most important predictor of having more severe pain. Tachycardia and systolic hypertension may also be important in younger and older patients, respectively. Simple correlation fails to show clinically important associations between prehospital vital signs and pain severity.
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The possible benefits of ultrasonic cardiac output monitoring (USCOM) in emergency medicine practice could be significant if evaluated in a goal-directed protocol. The aim of this study was to perform a feasibility study in a physician-staffed prehospital emergency medicine system. This study enrolled a convenient sample of 50 patients with circulatory distress. ⋯ In case of failure, the patient was very often dyspneic (80 vs. 23%, when the technique was successful, P<0.001). Mean duration of USCOM examination was 105 ± 60 s. The acceptable success rate for a new technique we observed and the high easy-to-use score suggests that the use of USCOM is feasible in prehospital emergency medicine.
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Participants in advanced resuscitation courses are often expected to learn to perform intraosseous access (IO). But how many learning modalities are needed to achieve procedural confidence in IO? We distributed an online questionnaire to members of emergency medicine, paediatric and anaesthesiology societies in Scandinavia. The responders without real-life experience with IO (n=322) were classified as 'not confident' or 'confident' in IO. ⋯ Confidence increased to 74.8% after one training modality, 87.9% after two modalities, 98.7% after three modalities and 100% after four modalities (P<0.0001). Of total responders 89.5% who had 'workshop or similar training with hands-on experience' as sole teaching method was confident. Confidence in IO increases with the number of learning modalities. 'Workshop or similar training with hands-on experience' as single training modality seemed as effective as the combination of two modalities.
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Fractured neck of femur (NOF) is a common injury in the elderly, which causes severe pain and distress. Fascia iliaca compartment block using the 'Two Pop Technique' is safe and relatively easy to perform. It has been traditionally performed by anaesthetists in a controlled environment for perioperative pain relief with very good results. The purpose of the study was to investigate its applicability and success rate in a busy emergency department (ED) with changing junior staff and time pressures. ⋯ The fascia iliaca compartment block offers a very good, efficient and safe alternative to conventional analgesia in the treatment of pain in patients with fractured NOF. It should be used more by EPs as it is easy to learn and it requires inexpensive equipment.
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Faster emergency response times are generally considered to have a positive effect on life expectancy of patients with a life-threatening event, leading many communities to determine response time intervals. However, worldwide, increasing urbanization and traffic congestion threatens ambulance response times. An emergency motorcycle response vehicle (MRV) can overcome these hurdles more easily than a larger ambulance. It also offers dispatch flexibility in responding to calls estimated to have a low likelihood of a patient who needs transport. The first aim of this study was to determine whether an MRV can shorten response times and impact on resuscitation outcomes in a heavily urbanized and densely populated region in the Netherlands. The second aim was to evaluate differences in dispatch and transport between MRV and ambulance. ⋯ Using motorcycles in a Dutch setting lead to better emergency medical service response times. The MRV serves a different population. Resulting in a higher treat and release rate and less transportation to hospital.