European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Clinical Trial
Prehospital intranasal evaporative cooling for out-of-hospital cardiac arrest: a pilot, feasibility study.
Intranasal evaporative cooling presents a novel means of initiating therapeutic hypothermia after an out-of-hospital cardiac arrest (OHCA). Few studies have evaluated the use of intranasal therapeutic hypothermia using the Rhinochill device in the prehospital setting. We sought to evaluate the use of Rhinochill in the Physician Response Unit of London's Air Ambulance, aiming to describe the feasibility of employing it during prehospital resuscitation for OHCA. ⋯ Intranasal evaporative cooling using the Rhinochill system is feasible in an urban, prehospital, doctor/paramedic response unit. Cooling with Rhinochill was not found to interfere with prehospital resuscitation and resulted in significant core body temperature reduction. Further research on the potential benefit of intra-arrest and early initiation of intranasal evaporative cooling is warranted.
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Observational Study
The paediatric psychiatric emergency population in a university teaching hospital in Belgium (2003-2008).
In the last few decades, there has been a remarkable increase in the number of children and adolescents presenting with psychiatric complaints to the emergency department in the USA. In Europe, however, less is known about the paediatric psychiatric emergency population. This study provides a clinical and demographic profile of this population and its service use in a European context. ⋯ Patients were predominantly female (57.3%) and adolescent (83.3%) and mostly referred for hostility and violence towards others (18.5%) and suicidal ideation (17.8%). For about 1/4 of the patients, PES was the first ever mental health treatment contact. PES could serve as a place for early detection and intervention and as an entry point to mental health services.
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Cardiopulmonary resuscitation guidelines are constantly optimized to increase survival. Keeping hands-off time brief is vital. Our hypothesis is that rhythm recognition is time-consuming during cardiopulmonary resuscitation. ⋯ For all rhythms, the mean time was 4.0 s (95% CI: 3.5-4.5). Of all shockable rhythms, 95.2 % were correctly diagnosed as shockable, compared with 88.6 % of nonshockable rhythms being correctly diagnosed. Our simulation study indicates that doctors are able to correctly identify shockable rhythms within 4 s.
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Previous studies have reported that civilian transport is a mortality risk factor in low-resource communities. Few studies have analyzed the chief complaints associated with mortality involving civilian transport after an earthquake.Therefore, the present study was conducted to determine whether mortality resulting from medical professional transport differs from that involving civilian transport, and if so, the chief complaints associated with mortality involving civilian transport after the Wen-chuan earthquake. ⋯ Altered mental status, trunk injury, and shortness of breath were the significant chief complaints associated with mortality involving civilian transport to the hospital after the Wen-chuan earthquake. Our data suggest that patients with any of these complaints should be transported by medical professionals, not civilians, to the nearest hospital for treatment.
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There is an ongoing shortfall of organs for donation in the UK and worldwide. Strategies including donation after circulatory death (DCD), living donation and better identification of potential donors are attempting to increase the number of donors and donated organs. The number of DCD donors in the UK increased by 808% from 37 to 336 between 2001 and 2010 and this is continuing to increase. ⋯ The process of DCD varies between different countries and institutions. The outcome of DCD transplantation has been largely encouraging, particularly for kidneys. The increase in DCD has led to an appraisal of issues that may arise during the donation process; these include the Lazarus phenomenon, the dead donor rule, perimortem interventions, public opinion and conflict of interest for clinicians.