European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Observational Study
Understanding the prehospital physician controversy. Step 2: analysis of on-scene treatment by ambulance nurses and helicopter emergency medical service physicians.
In our previous study, we identified the similarities and differences in competencies of ambulance nurses and helicopter emergency medical service (HEMS) physicians in the Netherlands. This ensuing study aims to quantify the frequency with which the additional therapeutic competencies of the HEMS physician are utilized and to determine whether this is the main reason for usefulness as perceived by ambulance nurses and HEMS physicians. ⋯ HEMS physicians provide additional treatment in 45% of patients. The additional treatment increases the perceived usefulness of the HEMS physician. The presence of the HEMS physician was also considered useful when the physician did not provide any additional treatment, possibly because of diagnostic competence and clinical decision-making.
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Observational Study
Goal-directed ultrasound in emergency medicine: evaluation of a specific training program using an ultrasonic stethoscope.
This observational study aimed to define the learning curve in goal-directed ultrasound (US) after a 2-day training course dedicated to novice emergency residents. ⋯ The performance of 30 supervised and goal-oriented examinations appeared adapted to adequately answer clinical questions covered by core applications of emergency US.
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Randomized Controlled Trial Comparative Study
Stethoscope versus point-of-care ultrasound in the differential diagnosis of dyspnea: a randomized trial.
We aimed to determine the accuracies of point-of-care ultrasound (PoCUS) and stethoscopes as part of the physical examinations of patients with dyspnea. Three emergency medicine specialists in each of two groups of ultrasound and stethoscope performers underwent didactic and hands-on training on PoCUS and stethoscope usage. ⋯ No significant differences were observed in the utility parameters of these modalities in these diagnoses. Although some authors argue that it is time to abandon the 'archaic tools' of past centuries, we believe that it is too early to discontinue the use of the stethoscope.
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With increasing rates of in-hospital cardiac arrest, improving resuscitation outcomes is essential. Mechanical chest compressors seem to be related to improved outcome in out-of hospital cardiac arrest; however, the literature on its use in in-hospital cardiac arrest is scarce. We used the Medline public database to systematically review patient outcomes considering mechanical cardiopulmonary resuscitation in in-hospital cardiac arrest. ⋯ Two studies did not report survival rates. Especially in patients with in-hospital cardiac arrest because of treatable causes, early start of mechanical chest compressions could improve future patient outcomes because of better (coronary and brain) perfusion during mechanical chest compressions compared with manual chest compressions. However, the current literature is probably influenced by publication bias and more high-quality research is needed.
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Comparative Study
A description of echocardiography in life support use during cardiac arrest in an Emergency Department before and after a training programme.
To investigate echocardiography in life support (ELS) use in Emergency Department (ED) cardiac arrest patients before and after a training day. ⋯ Use of ELS significantly increased after the training day most commonly supporting a decision to stop resuscitation. This change in practice has been maintained.