European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Prehospital anaesthesia using rapid sequence induction (RSI) is carried out internationally and in the UK despite equivocal evidence of clinical benefit. It is a core skill of the prehospital critical care service established by the Great Western Ambulance Service NHS Trust (GWAS) in 2008. This retrospective analysis of the service's first 150 prehospital RSIs describes intubation success rates and complications, thereby contributing towards the ongoing debate on its role and safety. ⋯ Prehospital RSI can be carried out safely, with intubation success rates and complications comparable with RSI in the emergency department. The variation in the intubation success rates between individual practitioners highlights the importance of ongoing performance monitoring, coupled with high standards of clinical governance and training.
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Randomized Controlled Trial Comparative Study
Reducing the potential for tourniquet-associated reperfusion injury.
Investigate a strategy to minimize tourniquet-associated reperfusion injury. ⋯ A staggered tourniquet release was associated with greater haemodynamic stability and reduced the rate of acute systemic metabolic changes associated with limb reperfusion. Reapplication of a tourniquet seemed to halt further reperfusion, providing a window period for patient evaluation and management.
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The aim of this paper, is to present a case to develop and test emergency department (ED)-specific approaches to improve the sequential detection, recognition and timely escalation of care for ED patients who have deteriorated after their initial triage and assessment. ⋯ A systematic approach to the early recognition of, and response to, deteriorating ED patients across the entire ED trajectory of care remains untested. Given the complexities of the ED environment, ward-based models of recognizing and responding to deteriorating patients may not meet the specific needs of the ED.
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Comparative Study
Undertreatment of pain in the prehospital setting: a comparison between trauma patients and patients with chest pain.
The aim of this study was to evaluate pain treatment with morphine administered by emergency medical service personnel (EMSP) to patients with chest pain and patients with pain in extremities because of trauma. This is a retrospective chart review of 2021 patients with chest pain and 887 patients with trauma. ⋯ Inadequate analgesia was frequently observed for both patient groups. The protocol was not fully utilized, suggesting that education in pharmacology and follow-up of the EMSP is required.
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Observational Study
EEG as a part of the decision-making process in the emergency department.
Although electroencephalography (EEG) is a useful diagnostic tool for patients with a suspected seizure, its value in informing the acute care of patients in the emergency department (ED) remains unclear. The aim of this study is to determine the effects of EEG results on subsequent patient management in or from the ED. ⋯ As seizure is a clinical event, EEG is not essential for diagnosing the presence of a seizure clinically in the ED. However, the results of EEG provide useful information especially for treatment choices. As the timing of the study affects the diagnostic efficacy of the test, EEG recordings should be performed within 24 h either in ED or in the epilepsy clinic.