European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Rapid sequence induction (RSI) provides prompt airway control during emergency evacuation of trauma patients. Physicians may be tasked to travel with paramedic ambulance crews to the scene of injury when RSI is more likely to be required. This study investigates whether there are any differences in the practice of prehospital RSI during emergency retrievals for trauma since the establishment of the regional Major Trauma Network (MTN) in March 2012. ⋯ The establishment of regional MTNs enables centrally tasked, 24-h physician availability for emergency trauma patients. There has been an increase in physician presence on emergency missions and increased frequency of RSI for at-risk trauma patients at times when there may previously have been an unmet requirement.
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Currently recommended cardiopulmonary resuscitation (CPR) guidelines to change rescuers in 2-min intervals do not consider the differences in the physical capability of individual rescuers. We compared the quality of chest compressions between the conventional rescuer rotation method (RC2, rescuers changed in 2-min intervals) and the novel rescuer rotation method (RCL, rescuers changed by a team leader's decision on the basis of gross assessment of the quality of chest compression). ⋯ The quality of chest compression was better with RCL than the conventional RC2 method in terms of compression depth and proportions of correct compressions. RCL may be a practical alternative rescuer change strategy during uninterrupted chest compressions, especially when objective parameters to monitor the quality of chest compression are not readily available.
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Emergency admissions are rising, but little is known about the patient perspective. We aimed to explore the views of patients assessed for admission in terms of (i) whether they expected to be admitted, (ii) the comfort, convenience and safety of admission and (iii) whether satisfaction with care was influenced by expectations of admission being met. ⋯ Most patients being assessed for admission do not expect to be admitted, but most report positive views about the safety, comfort and convenience of hospital admission. We found no evidence of reduced satisfaction if expectations about admission are not met.
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Haemorrhage remains among the most preventable causes of trauma death. Massive transfusion protocols, as part of 'haemostatic resuscitation', have been implemented in most trauma centres. Relative to the attention to the ideal ratio of red blood cells to fresh frozen plasma and platelets, cryoprecipitate treatment has been infrequently discussed. We aimed to outline the use of cryoprecipitate during trauma resuscitation and analyse outcomes in patients who received cryoprecipitate after hypofibrinogenaemia detection. ⋯ Administration of cryoprecipitate was uncommon during trauma resuscitation, even among patients with hypofibrinogenaemia on presentation. This study provides no evidence towards improved outcomes from administration of cryoprecipitate.