European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The aim of this paper, is to present a case to develop and test emergency department (ED)-specific approaches to improve the sequential detection, recognition and timely escalation of care for ED patients who have deteriorated after their initial triage and assessment. ⋯ A systematic approach to the early recognition of, and response to, deteriorating ED patients across the entire ED trajectory of care remains untested. Given the complexities of the ED environment, ward-based models of recognizing and responding to deteriorating patients may not meet the specific needs of the ED.
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Comparative Study
Undertreatment of pain in the prehospital setting: a comparison between trauma patients and patients with chest pain.
The aim of this study was to evaluate pain treatment with morphine administered by emergency medical service personnel (EMSP) to patients with chest pain and patients with pain in extremities because of trauma. This is a retrospective chart review of 2021 patients with chest pain and 887 patients with trauma. ⋯ Inadequate analgesia was frequently observed for both patient groups. The protocol was not fully utilized, suggesting that education in pharmacology and follow-up of the EMSP is required.
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Observational Study
EEG as a part of the decision-making process in the emergency department.
Although electroencephalography (EEG) is a useful diagnostic tool for patients with a suspected seizure, its value in informing the acute care of patients in the emergency department (ED) remains unclear. The aim of this study is to determine the effects of EEG results on subsequent patient management in or from the ED. ⋯ As seizure is a clinical event, EEG is not essential for diagnosing the presence of a seizure clinically in the ED. However, the results of EEG provide useful information especially for treatment choices. As the timing of the study affects the diagnostic efficacy of the test, EEG recordings should be performed within 24 h either in ED or in the epilepsy clinic.
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The aim of this study was to describe baseline coagulation in patients presenting to the emergency department (ED) with a ruptured abdominal aortic aneurysm (rAAA) and its effect on survival. ⋯ Although coagulopathy is often present in patients presenting with a rAAA, it does not seem to be associated with a poorer outcome. Our results seem to suggest that altering the current practice of minimal transfusion in the ED to include early transfusion of blood products, such as platelets or fresh frozen plasma, is therefore unlikely to improve outcome.
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The aim of this study was to describe the demographic, social and medical characteristics, and healthcare use of highly frequent users of a university hospital emergency department (ED) in Switzerland. ⋯ Highly frequent users of a Swiss academic ED are a highly vulnerable population. They are in poor health and accumulate several risk factors of being even in poorer health. The small number of patients and their high level of insurance coverage make it particularly feasible to design a specific intervention to approach their needs, in close collaboration with their primary care practitioner. Elaboration of the intervention should focus on social reinsertion and risk-reduction strategies with regard to substance use, hospital admissions and suicide.