European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The aim of the study was to provide an overview on the current evidence on the method of cardioversion in patients presenting with recent-onset atrial fibrillation at the emergency department. ISI Web of Science and MEDLINE were explored for articles published between January 2000 and December 2011 in English or Spanish for the keywords 'acute', 'recent-onset' or 'paroxysmal' AND 'atrial fibrillation' AND 'treatment' AND 'emergency'. Original published articles were included if they enrolled patients with atrial fibrillation episodes of short duration (<48 h) and if they specifically addressed time to conversion, length of stay in the emergency department, safety, and/or relapses. ⋯ Amiodarone had a longer conversion time, with a similar rate of acute adverse events. Cardioversion in the emergency department is feasible and safe. Direct current cardioversion is the most effective therapeutic strategy.
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For the first time in the Emergency Department (ED), to assess the use of rotational thromboelastometry (ROTEM) in patients presenting with all-cause haemodynamic shock, specifically (a) to establish whether a 5- min (A5) or a 10-min result (A10) is accurate compared with a final maximum clot firmness (MCF) result; (b) to compare time to A10 and formal laboratory coagulation result; (c) to assess whether bleeding ED trauma, gastrointestinal and aortic aneurysm patients are coagulopathic according to ROTEM; and (d) to compare ROTEM results with formal laboratory coagulation parameters. ⋯ Eighteen percent of bleeding ED patients are coagulopathic using ROTEM including 25% of trauma patients. A 10-min ROTEM clot firmness (A10) is an excellent surrogate for MCF and allows a result to be obtained earlier than formal laboratory results and potentially within 10 min of the patient arriving in the ED.
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Emergency departments (EDs) are the basic unit of emergency medicine, but often differ in fundamental features. We sought to describe and characterize EDs in Denmark. ⋯ Although there is some variation in their layout and characteristics, most Danish EDs have a high degree of resource availability and are able to treat common emergencies. As Denmark seeks to reform emergency care through ED consolidation, this national survey helps to establish a benchmark for future comparisons.
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In-hospital primary surveys undertaken on traumatically injured patients can be inaccurate and incomplete. This study examined the documentation of prehospital primary surveys conducted by Greater Sydney Area Helicopter Emergency Medical Service registrars on trauma patients. ⋯ Helicopter emergency medical service registrars do not comprehensively document prehospital primary surveys on traumatically injured patients. However, emergency medicine trainees document more completely than anaesthetic trainees. Individual registrar variation contributes significantly towards the completeness of prehospital primary survey documentation.
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Pain is a common presenting complaint of emergency department patients. Providing instructions that can be easily recalled by patients is an important step in enabling patients to manage their pain following discharge. The effect of the introduction of written discharge instructions for pain medication on patients' recall of instructions was evaluated in this study. ⋯ In the second phase, significantly more patients, 71% (P<0.01), were able to recall the instructions correctly. Results of this study support the hypothesis that it makes sense to provide patients with written instructions about the appropriate use of analgesics, and that emergency departments that are not yet doing this should consider introducing this policy. It is a relatively low-cost measure that could lead to a significant improvement in quality of care.