European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Improved physiologic status can be seen as a surrogate measure of improved outcome and a field-friendly prognostic model such as the Mainz Emergency Evaluation Score (MEES) could quantify the effect on physiological response. We aim to examine the dynamic physiological profile as measured by this score on patients managed by physician-manned helicopter emergency medical services and how this profile was related to on-scene time expenditure and critical care interventions. ⋯ Restoring deranged physiology remains a mantra for all critical care practitioners. We have shown that this is also possible in the prehospital context, even when prolonging on-scene time, and after initiating advanced procedures.
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Observational Study
Lactate - Arterial and Venous Agreement in Sepsis: a prospective observational study.
Sepsis is a common condition in the emergency department (ED). Lactate measurement is an important part of management: arterial lactate (A-LACT) measurement is the gold standard. There is increasing use of peripheral venous lactate (PV-LACT); however, there is little research supporting the interchangeability of the two measures.If PV-LACT has good agreement with A-LACT, it would significantly reduce patient discomfort and the risks of arterial sampling for a large group of acutely unwell patients, while allowing faster and wider screening, with potential reduced costs to the healthcare system. ⋯ This study is the largest comparing the two measurements, and shows good clinical agreement. We recommend using PV-LACT in the routine screening of septic patients. A PV-LACT less than 2 mmol/l is predictive of an A-LACT less than 2 mmol/l.
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We examined whether teleconsultation from ambulances to a physician at an emergency medical communication center (EMCC) would increase the proportion of patients with nonurgent conditions being treated and released on site. ⋯ Teleconsultation between a physician at the EMCC and ambulance personnel and noncritically ill 1-1-2 patients results in an increased rate of patients treated and released with high satisfaction. The approach does not seem to compromise patient safety.
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The role of emergency physicians is to identify patients in need of immediate treatment, but also to identify symptoms indicative of serious, if not immediately life-threatening conditions. ⋯ A small percentage of patients discharged with NSAP from Swedish EDs are diagnosed with a malignancy within a year. Patients aged 60 years or older and with comorbidities were over-represented in terms of developing malignancies after discharge. Emergency physicians should be aware of the fact that diffuse abdominal symptoms in elderly patients could be the first sign of an underlying malignancy and more liberally refer such patients for follow-up in primary care.
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The aim of this study is to determine the period prevalence, nature and causes of workplace chemical and toxin exposures reported to the Victorian Poisons Information Centre (VPIC). ⋯ Mild-moderately important workplace exposures are common. Significant variations exist between the sexes and seasons. Poisons Information Centres may play a role in ongoing surveillance of chemical and toxin exposures and a minimum exposure dataset is recommended.