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 determine the prevalence and prognostic value of troponin elevation at emergency department (ED) presentation in patients admitted with an exacerbation of chronic obstructive pulmonary disease (COPD). A retrospective cohort study of ED patients with acute exacerbations of COPD who were admitted to hospital and in whom troponin was assayed at ED presentation. Other data collected included demographics, clinical characteristics, test results, and outcome. ⋯ Seventy-eight patients had elevated troponin of greater than 99th centile (31%, 95% CI 26-37%). Factors independently associated with mortality were troponin elevation [odds ratio (OR) 8.3, 95% CI 1.58-43.7], pH less than 7.2 (OR 12.7, 95% CI 1.86-86.4), and requirement for noninvasive ventilation (OR 8.09, 95% CI 1.61-40.8). In conclusion, troponin elevation is associated with increased in-hospital mortality in ED patients with acute exacerbation of COPD.
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The aim of the study was to evaluate the prevalence and the risk factors of ventilation-associated pneumonia (VAP) for out-of-hospital or in the emergency department intubated patients. This was a retrospective descriptive study. All intubated adults subsequently admitted to the ICU over 1-year period were included. ⋯ Death rate was 17% and was not significantly higher for patients with VAP (P=0.9; 95% CI 0.32-4.95%). Emergency care workers should be aware of the potential 20% occurrence of VAP when they intubate and ventilate a patient. Preventive strategies, which have been proven effective in ICUs, should be implemented in the emergency setting.
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Despite an increase in research, there is still a lack of knowledge about patient safety in emergency departments (EDs) in many European countries. The aim of this study was therefore to describe the incidence and types of reported medical errors and complaints in ED care in Sweden. ⋯ Medical errors and complaints at Swedish EDs, as reported by both patients and care providers, were related mainly to diagnostic procedures and treatments.
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We aimed to assess the suitability of right ventricular outflow tract (RVOT) fractional shortening for estimating low central venous pressure (CVP). To the best of our knowledge, there have been no similar studies in the English language literature. ⋯ In the hands of emergency physicians, a RVOT fractional shortening measurement is a good predictor of low CVP.
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The intra-aortic balloon pump (IABP) was first introduced in 1968 to augment cardiac output in the haemodynamically unstable patient and serve as a bridge to treatment options such as coronary artery bypass grafting and cardiac transplantation. Transfer of IABP-dependent patients for upgrade of clinical care is increasingly common and safe. In Australia, percutaneous coronary intervention centres can be located outside cardiothoracic surgical centres. This study reviews IABP medical retrieval by a doctor/paramedic team after implementation of a standardized protocol. ⋯ Our system offers a safe method of IABP medical retrieval. The doctor and paramedic combination complements strengths in logistics and critical care. This serves as a guide to other systems looking to put in place a similar model of care.