European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The clinical and radiological findings in some hand injuries can be subtle and easily misinterpreted, leading to irreversible changes and profound functional loss. The importance of early and accurate diagnosis is clear. This study looks at four such injuries, with reference to pertinent anatomy, typical mechanisms of injury, examination and radiological findings, with emphasis on avoiding pitfalls in the emergency department.
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The clinical diagnosis of urinary tract infection (UTI) in infants under the age of 2 years is challenging because of the nonspecific symptoms and signs in this age group. Prompt diagnosis and treatment is critical, and although dipstick testing allows rapid testing, there is some doubt about its use in infants. We sought to show the use of the dipstick test in identifying or excluding UTI in infants under the age of 2 years presenting to the emergency department with a febrile illness. ⋯ In febrile infants who were below 2 years of age, dipstick urinalysis shows promising results in identifying or ruling out a UTI.
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Family presence during invasive procedures (IPs) is infrequent in Spanish pediatric emergency departments (PEDs), despite the benefits of family presence. ⋯ Most of the parents wish to stay beside their children during IPs. In our PED, parents were present for more than 95% of IPs. The more invasive the procedure is, the more anxious parents feel.
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The actual impact of emergency department (ED) 'wait' time on hospital mortality in patients admitted as a medical emergency has often been debated. We have evaluated the impact of such waits on 30-day mortality, for all medical patients over a 7-year period. ⋯ Delay to admission have been shown to be independently adversely related to mortality outcome. We recommend maximal target limits of 4 and 6 h for referrals and admissions, respectively, based on these mortality observations.
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The Revised Trauma Score is used worldwide in the prehospital setting and provides a snapshot of patient's physiological state. Several studies have shown that the reliability of the RTS is high in trauma outcomes. In the Netherlands, Helicopter Emergency Medical Services (HEMS) are mostly used for delivery of specialized trauma teams on-scene and occasionally for patient transportation. In our trauma system, the Emergency Medical Services crew performs triage after arrival on-scene and cancels the HEMS-dispatch if deemed unnecessary. In this study we assessed the ability of a maximum on-scene Revised Trauma Score (RTS=12) to be used as a triage tool for HEMS cancellation. ⋯ The RTS alone is not a reliable triage tool for HEMS cancellations in our trauma system and will lead to a considerable rate of undertriage with one in every six cancellations being incorrect. Other criteria based on patient's vital signs, combined with anatomical and mechanism of injury parameters should be developed to safely minimize triage errors.