European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Patients with undifferentiated acute abdominal pain (AAP) frequently present to the Emergency Department (ED). The most common diagnosis is the nonspecific abdominal pain although missed occult surgical pathology in the haemodynamically stable patient with equivocal symptoms and signs is a potential source of morbidity. The objectives of this study were two-fold. Firstly, to ascertain the accuracy of ED clinicians in the diagnosis of AAP, and to delineate if there was a population of patients who would normally require admission to hospital that would be suitable to be managed on a Clinical Decision Unit (CDU) protocol. Secondly, to prospectively evaluate such a strategy by way of a pilot study. ⋯ The management of stable AAP within the ED environment on a well-defined CDU pathway is feasible and can facilitate safe, efficient and effective care with early discharge and an increase in the accuracy of the final diagnosis.
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To introduce an external landmark for optimizing probe placement during Focused Assessment with Sonography for Trauma (FAST) exam. ⋯ The HS line is an external landmark that may optimize probe placement and facilitates teaching and performance of FAST examination.
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To evaluate the interrater reliability and parallel forms reliability of transcutaneous Doppler ultrasonography (TCDU) and impedance cardiography (ICG) in clinically and hemodynamically stable emergency department patients. ⋯ Both TCDU and ICG have fair interrater reliability of SV independent of operator experience. A statistically significant relationship exists between the two devices but this does not produce predictable values in SV. Over time comparative results become less biased but remain limited by a great degree of variability.
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In the Netherlands, a patient's first contact with a general practitioner cooperative, an out-of-hours primary-care center, is usually with a triage nurse. Previous research has shown that nurses sometimes underestimate the level of urgency, which may be caused by incomplete history taking. The aim of this study was to examine the relation between comprehensiveness of history taking and appropriateness of urgency estimation. ⋯ Incomplete asking of recommended questions through telephone triage was not associated with underestimation of urgency. Pattern recognition may be more important for identification of urgent health problems by nurses than asking all crucial questions during history taking.
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When managing airways in a prehospital setting, emergency physicians have to deal with difficult intubation (DI), which increases morbidity and mortality. The primary goal of this study was to determine predictors of DI in the out-of-hospital field faced by the French physician-staffed Emergency Medical Service. ⋯ For prehospital orotracheal intubation, independent risk factors of DI are a mental-thyroid distance less than three fingers, a patient on the floor, and a superior airways obstruction. Anticipation of DI could result in fewer attempts, and fewer complications, as the rate of complication increases with the difficulty of intubation.