European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The main purpose of this article is to provide some practical insights into acid-base disorders interpretation, comparing the three most widespread diagnostic approaches. After a brief summary of the history of blood gas analysis and the shift from a purely chemical approach to more clinically useful applications, the pros and cons of the different methodologies are compared and discussed. Reviewing the most important publications in the field, the authors attempt to show that each diagnostic strategy is acceptable, although the one based on base-excess calculation perhaps seems too 'rough' to understand the mixed disorders, whereas the Stewart approach is attractive from a chemical point of view, but unsuitable for the emergency physician because of the cumbersome calculations needed. Finally, the anion gap and 'expected compensation' approach seems to be more comprehensive and feasible at the bedside.
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Toddler's fracture (TF) occurs in young children after minor trauma. Clinical diagnosis can be challenging and initial radiological evidence may be lacking. The aim of this study was to compare the management and outcomes of clinically diagnosed TF patients with and without initial radiological evidence. ⋯ There were no complications with management in or out of cast. The initial presumptive clinical diagnosis of TF may be as significant as that with radiological confirmation. Follow-up imaging is unlikely to affect management if the diagnosis remains clinically clear.
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The aim of this study was to describe the aetiology and severity of head injury in an infant (age<1 year) population presenting to a Scottish Paediatric Emergency Department (PED) and to discern preventable risk factors. The records of infants who presented to the PED of the Royal Aberdeen Children's Hospital between September 2010 and December 2011 with isolated head trauma were reviewed, patient demographics were extracted and information on aetiology, including nonaccidental injury (NAI), was recorded. Of 1574 attendances, 233 suffered isolated head injury. ⋯ The most common mode of injury was fall from a height (37%). Infants commonly present to the PED with head injury, many of which should be easily preventable. The number of cases because of NAI in our population is smaller than previously published figures.
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Community-acquired pneumonia (CAP) is associated with high in-hospital mortality. Standardization of diagnostics and adherence to sepsis bundles in the emergency department (ED) are associated with reduced mortality in patients with sepsis. We examined whether introduction of standardized care bundles and checklists in the ED is associated with reduced mortality in patients hospitalized for CAP. ⋯ This study demonstrated that implementation of standardized CAP care bundles in the ED is associated with a 21% relative risk reduction of in-hospital mortality. Standardization of diagnostic and therapeutic processes in the ED improves outcome of patients hospitalized for CAP.
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Adequate chest compression (CC) depth is crucial for resuscitation outcomes. Lightweight rescuers, particularly women, are often unable to achieve the required 5-6 cm CC depth. This nonrandomized cohort study investigated new strategies to improve CC performance. ⋯ A simple 5-s instructor's intervention during the CPR training significantly improved the performance of the female rescuers and helped them achieve the CC depth required by 2010 resuscitation guidelines. Andrew's manoeuvre is most effective among the women with the lowest body weight.