European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Observational Study
Trauma in the elderly in Trinidad and Tobago: a cross-sectional study.
Little is known about trauma in the elderly in the developing world. This study compared injuries in older patients with those in younger adults in a Third World setting. This was a prospective observational study of trauma admissions to a tertiary hospital in Trinidad, comparing injury characteristics and patient outcomes in older versus younger adults. ⋯ Trauma in the elderly in Trinidad is similar to that in the developed world. Public health measures in developing countries should be aimed at preventing falls in older persons. The burden of trauma in the elderly is likely to increase in developing countries as the population ages.
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This is a systematic review of the literature to compare the efficacy of calcium channel blockers to β-blockers for acute rate control of atrial fibrillation with rapid ventricular response in the emergency department setting. PubMed, EMBASE, and the Cochrane Registry were searched. Relative risk (95% confidence interval) was calculated between drugs and methodological quality of included studies was evaluated. ⋯ These were randomized double-blinded studies (n=92) comparing intravenous diltiazem with intravenous metoprolol. The combined relative risk of acute rate control by diltiazem versus metoprolol was 1.8 (95% confidence interval 1.2-2.6). On the basis of the paucity of available evidence, diltiazem may be more effective than metoprolol in achieving rapid rate control, but high-quality randomized studies are needed.
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Observational Study
Can emergency medicine practitioners predict disposition of psychiatric patients based on a brief medical evaluation?
Emergency medicine practitioners (EMPs) often provide 'medical clearance' before evaluation by a psychiatry practitioner (PP). We set out to determine the level of agreement between EMP impression and disposition as determined by PPs. ⋯ EMPs did not reliably predict psychiatric disposition decisions based on clinical 'gestalt'. Future research will focus on clinical guidelines to help EMPs better independently assess need for emergency psychiatric services.
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The aim of this study was to identify predictors of ICU transfer or death within 48 h obtainable within 4 h of admission in emergency department (ED) patients with suspected infection. ⋯ Readily available clinical and laboratory variables at arrival in the ED can support identification of late deterioration leading to ICU transfer or death within 48 h of admission.
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High blood pressure (HBP) is observed frequently in patients with spontaneous intracerebral haemorrhage (SICH). Although HBP at admission has been associated with poor outcomes, most studies from which such conclusions were derived had been carried out decades earlier, when aggressive BP management was not implemented. In our institution, SICH patients showing HBP undergo aggressive BP management by intravenous nicardipine with target systolic BP (SBP) less than 140 mmHg. We investigated whether responsiveness to intravenous nicardipine, haematoma expansion rate and activity of daily living 90 days after admission differed by the degree of admission SBP. ⋯ The lack of difference in the demographic and outcome variables in SICH patients managed by aggressive treatment to normalize the BP indicates that the previously reported association between HBP at admission and poor outcomes needs to be re-evaluated.