European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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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.
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The most common method of assessing the quality of medical education is through a selection of qualitative assessments, usually as part of a programme evaluation. Common qualitative assessments include measurements of students' and teachers' participation, outcome measures such as assessment results, and qualitative assessments such as interviews and questionnaires of students and teachers. Programme evaluation can therefore be a process that is both laborious and subject to accusations of a lack of objectivity. ⋯ The assessment tool is less accurate at ranking those training centres whose training is merely 'satisfactory'; whether this is a result of the imprecision of the tool itself or a reflection of the subjective nature of the current assessment (i.e. whether the current evaluation system lacks validity) cannot be stated. In summary, it appears to be possible to use a single quantitative tool to reliably, and with validity, measure the quality of training delivered at a postgraduate medical training centre. Although it is not envisaged that this would, or should, replace ongoing quality assurance systems such as programme evaluations, a validated tool can be derived for a given setting to usefully inform and augment current quality management systems in postgraduate medical education.
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Comparative Study
First-pass intubation success rate during rapid sequence induction of prehospital anaesthesia by physicians versus paramedics.
Endotracheal intubation is a frequently performed procedure for securing the airway in critically injured or ill patients. Performing prehospital intubation may be challenging and intubation skills vary. We reviewed the first-attempt tracheal intubation success rate in a Dutch prehospital setting. ⋯ Prehospital intubations had a significantly higher success rate when performed by helicopter physicians. We promote a low threshold for HEMS deployment in cases of a potentially compromised airway.