European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Despite the extensive literature on drowning, clinical data are still lacking on the best medical strategy to use. Acute respiratory failure (ARF) is the main component of drowning pathophysiology. The objectives of this multicenter study were to analyze the clinical course of drowning-related ARF patients and to describe the efficacy of the ventilatory strategies used. ⋯ Despite the absence of recommendation for NIV use in case of drowning-related ARF, this technique was often used with safety and efficacy. The decision for NIV use was mainly based on the preserved or improved neurological status.
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In out-of-hospital cardiac arrest (OHCA), neurological outcome is determined by the severity of neurological injury, early percutaneous coronary intervention, and application of neuroprotective temperature management. As this is a very time-intensive and manpower-intensive protocol, we hypothesized that there would be a difference in outcome between OHCA patients admitted during and out of office hours. ⋯ Survival until 180 days between OHCA patients admitted during office hours or out of office hours was not significantly different in two hospitals with a fixed protocol for neuroprotection and 24/7 streamlined access to coronary angiography.
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Prehospital recognition of an acute stroke improves the time from onset to thrombolysis and rates of reperfusion therapy. Studies conducted to evaluate paramedic and dispatcher performance in suspecting stroke are disappointing. This study addresses the specific issue of stroke recognition by dispatchers, taking into account delay in reporting the onset of symptoms (<5 h). ⋯ The revised Cincinnati Stroke Scale for dispatch adds the notion of delay in the process of triage. It identifies 67.8% and misses 32.2% of the stroke patients treated by thrombolysis. Its performance is similar to previous results using the regular Cincinnati Stroke Scale, but allows for targeting acute strokes.
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Previous work has demonstrated that much violence requiring medical help is not recorded by the police. Sharing emergency department data on victims of violence is associated with reductions in community violence and is well established throughout the UK. We undertook a critical literature review to determine whether sharing ambulance data was useful to identify violence hotspots and offered unique information for violence prevention. ⋯ Although the standard of evidence was generally low, most studies demonstrated that ambulance services detected a substantial proportion of assaults that were not recorded by the police or the emergency departments. We identified only two interventional studies, but they were of low quality. Although the interventional evidence base is currently weak, ambulance data provide a unique source of information about the epidemiology of community violence and have the potential to improve current violent crime surveillance methods.
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Multicenter Study Observational Study
Emergency department procedural sedation: the London experience.
The aim of this study was to develop a procedural sedation guideline and an audit tool to identify the medications chosen, the incidence of predefined adverse events and the factors associated with their occurrence. ⋯ Procedural sedation and analgesia can be safely and effectively performed in the ED by appropriately trained emergency physicians.