European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study
The utility of shock index in differentiating major from minor injury.
The importance of early recognition of hemorrhagic shock and its effects on outcome have long been recognized. Traditional vital signs are relatively insensitive as early diagnostic markers of hemorrhage. The shock index (SI); heart rate (HR) divided by systolic blood pressure (SBP), has been suggested as such a marker. We tested the diagnostic utility of the SI in differentiating major from minor injury in trauma patients. ⋯ The SI can be a valuable tool, raising suspicion when it is abnormal even when other parameters are not, but is far too insensitive for use as a screening device to rule out disease. A normal SI should not lower the suspicion of major injury.
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Randomized Controlled Trial Comparative Study
Comparison of GlideScope video laryngoscope and intubating laryngeal mask airway with direct laryngoscopy for endotracheal intubation.
The aim of this study was to determine whether GlideScope video laryngoscope (GVL) and intubating laryngeal mask airway (i-LMA) improve the intubation success rate and could be easily learned and performed by paramedic students when compared with the direct laryngoscopic (DL) method. The study was designed as a prospective randomized crossover trial that included 121 paramedic students. All participants were asked to intubate each Ambu Airway Management Trainer manikins after the lecture and demonstration. ⋯ Success rates of i-LMA and GVL were significantly higher compared with DL (P=0.005 and P=0.006, respectively). No significant difference was determined between i-LMA and GVL in terms of successful intubation (P>0.05). This study showed that GVL and i-LMA provided better intubation success rates and were easier for paramedic students when compared with the classic DL method.
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Comparative Study
Interrater agreement: a comparison between two emergency department triage scales.
The aim was to elucidate if, by strictly applying the Adaptive Process Triage (ADAPT) scale, the interrater agreement increased among the participating registered nurses (RNs) than when triaging according to the older scale, which allowed subjective interpretations of signs and symptoms. ⋯ Both the triage scales showed moderate overall agreements, while dispersion of triage decisions across several triage levels declined when ADAPT was used. Although the algorithm for acuity allocation by ADAPT seemed well defined, many patient scenarios were triaged as both unstable and stable and thus allocated to various triage levels. If ADAPT is to function as a safe triage tool with low interrater variability, further revision of the triage algorithms is needed.
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Serious pulmonary and cardiac failure may be treated with extracorporeal membrane oxygenation (ECMO) when the conventional treatment fails. Improvements in extracorporeal circulation devices have allowed us to set up two specialized mobile units: a mobile cardiac assistance unit (MCAU) and a mobile respiratory assistance unit (MRAU). Their role is to provide ECMO at patient's bedside, and then to ensure inter-hospital transport (IHT). The aim of this study was to evaluate our experiences with the transportation of patients on ECMO. ⋯ This study shows that mobile ECMO system can be successfully and quickly established at patient's bedside, and that transportation of patients on ECMO can be performed safely and without technical difficulties.
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Comparative Study
Accuracy of prehospital triage of trauma patients by emergency physicians: a retrospective study in western Switzerland.
Accurate identification of major trauma patients in the prehospital setting positively affects survival and resource utilization. Triage algorithms using predictive criteria of injury severity have been identified in paramedic-based prehospital systems. Our rescue system is based on prehospital paramedics and emergency physicians. The aim of this study was to evaluate the accuracy of the prehospital triage performed by physicians and to identify the predictive factors leading to errors of triage. ⋯ Physicians using clinical judgement provide effective prehospital triage of trauma patients. Only a few factors predicting errors in triage process were identified in this study.