European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The aim of this study was to compare vital signs of minimally injured and moderately injured patients during ambulance transport and subsequent emergency department (ED) assessment. We carried out a retrospective chart review. Patients were divided into two groups: minimally injured patients with neck pain (group 1) and moderately injured patients with a closed ankle or wrist fracture (group 2). ⋯ There was no significant difference in respiratory rate in group 1 or any of the vital signs in group 2. We conclude that transport anxiety has minimal effect on vital signs. In trauma, clinicians should exclude tissue injury before attributing increased systolic blood pressure or heart rate to anxiety.
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There are no prospective data on which ischemic stroke patients require endotracheal intubation. This retrospective observational study describes the characteristics and outcomes of adult ischemic stroke patients admitted to two emergency department (ED)-ICU from January 2005 to October 2011 and who were intubated before imaging, either during the prehospital or the ED phase of care. Data were extracted from hospital charts and analyzed using descriptive statistics. ⋯ Twenty-six patients (84%) died during their hospital stay. The proportion of ED ischemic stroke patients intubated before imaging was very low. Almost all were severely ill and the majority died.
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Review Meta Analysis
The role of venous blood gas in the Emergency Department: a systematic review and meta-analysis.
The aim of this study is to provide a systematic review of the literature reporting agreement between arterial and venous pH, partial pressure of carbon dioxide (PCO2), bicarbonate (HCO3⁻), base excess and lactate; and to perform a meta-analysis of the differences. Medline and Embase searches using Eduserv Athens from 1950 to present were conducted using the terms 'VBG', 'ABG', 'arterial', 'venous', 'blood', 'gas', 'lactate', 'emergency' and 'department'. References of the published papers were hand searched and full-text versions of those deemed helpful to the question were obtained. ⋯ Arteriovenous agreement for PCO2 is poor and PvCO2 cannot be relied upon as an absolute representation of PaCO2. However, normal peripheral PvCO2 has a good negative predictive value for normal arterial PCO2, and a normal PvCO2 can be used as a screen to exclude hypercapnic respiratory disease. There may be a poor agreement between arterial and venous lactate at abnormal values; however, if the venous lactate is normal, it is likely the arterial values of this parameter will also be normal.
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We aimed to implement the European Resuscitation Council (ERC) basic life support (BLS) and automated external defibrillator (AED) course as a mandatory peer-led training programme for medical students and to evaluate the satisfaction with this course. Medical students certified as ERC BLS/AED instructors were recruited as student trainers and organizers of the course, which was included as a mandatory part of the curriculum for second-year medical students before first clinical rotation. After each course, questionnaires were distributed to evaluate the peer-led training programme. ⋯ The quality of the course was rated as 9.4±0.8 (10-point scale, 10 being best), and the majority (95%) felt better prepared for their clinical rotation. Implementation of the ERC BLS/AED course as a mandatory peer-led training programme for medical students is feasible. The course has been very well accepted and the students feel better prepared for their first clinical rotation.
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In emergency departments (EDs), overcrowding, workload complexity, and cost containment represent current operational problems. In this retrospective observational study, we analyzed the effects of a professional quality management (QM) system on patient flow, diagnostic validity, and hospital costs. ⋯ The introduction of a professional QM system in EDs improves patient flow as well as quality of medical care and results in a significant reduction in hospital costs. Further analyses should evaluate the effects of QM on quality indicators in a prospective multicenter study. Validation of results has to be performed in a dynamic model for process simulation.