European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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When faced with an out-of-hospital cardiac arrest patient, prehospital and emergency resuscitation providers have to decide when to commence, continue, withhold or terminate resuscitation efforts. Such decisions may be made difficult by incomplete information, clinical, resourcing or scene challenges and ethical dilemmas. This systematic integrative review identifies all research papers examining resuscitation providers' perspectives on resuscitation decision-making for out-of-hospital cardiac arrest patients. ⋯ Established prognostic factors are generally considered important, but there is a lack of resuscitation provider consensus on other factors, indicating that decision-making is influenced by the perspective of resuscitation providers themselves. Resuscitation decision-making research typically draws conclusions from evaluation of cardiac arrest registry data or clinical notes, but these may not capture all salient factors. Future research should explore resuscitation provider perspectives to better understand these important decisions and the clinical, ethical, emotional and cognitive demands placed on resuscitation providers.
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To investigate the demographic and service characteristics, motive for consultation, and disposition of adult frequent users (FUs) of the largest academic hospital in the Netherlands over a 5-year period. ⋯ Frequent use of the ED has been depicted as inappropriate use of these services. However, our study shows that FUs consist of a relatively small number of patients and that FUs suffer from chronic, and often, severe somatic illnesses that require specialized medical care.
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Frequent Emergency Department (ED) users are vulnerable individuals and discrimination is usually associated with increased vulnerability. The aim of this study was to investigate frequent ED users' perceptions of discrimination and to test whether they were associated with increased vulnerability. ⋯ Frequent ED users are highly likely to report perceived discrimination during ED use, and this was linked to a decrease in their own rating of their health. Hence, discrimination should be taken into account when providing care to such users as it may constitute an additional risk factor for this vulnerable population. Perceived discrimination may also be of concern to professionals seeking to improve practices and provide optimal care to frequent ED users.
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Until recently, traumatic cardiac arrest (tCA) was believed to be associated with high mortality and low survival rates. New data suggest better outcomes. The most common error in tCA management is failing to treat a tension pneumothorax (TP). In the prehospital setting, we prefer thoracostomies for decompressing a potential TP in tCA cases; however, interventions can only be recommended with adequate information on their results. Therefore, we reviewed the results of thoracostomies performed by our Helicopter Emergency Medical Service. ⋯ The outcomes of patients with tCA who underwent prehospital thoracostomy were poor in our group. The early identification of TP and strict algorithm adherence in tCA may improve outcomes. In the future, to reduce the risk of unnecessary thoracic interventions in tCA, ultrasound examination may be useful to identify TP before thoracic decompression.