European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The 'clinical scaphoid fracture' remains a common problem faced by emergency physicians. Early magnetic resonance imaging (MRI) has been used to routinely investigate such patients presenting to the emergency department of Aberdeen Royal Infirmary since 2002. The aim of this study was to evaluate the effectiveness of this strategy in the diagnosis of occult scaphoid fracture. ⋯ Early MRI can reliably detect radiologically occult scaphoid fractures and accurately delineate the anatomy of other injuries that may present with similar symptoms. This strategy avoids further radiation and can be incorporated as a part of an emergency department management pathway. Early and accurate diagnosis is in the patient's interest and allows timely intervention.
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Comparative Study
The definition of massive transfusion in trauma: a critical variable in examining evidence for resuscitation.
'Massive' transfusion is a poorly defined inclusion criteria for studies examining the blood and blood product that are used during trauma resuscitation. We aimed to compare the traditional definition of massive transfusion (≥10 units in 24 h) to a more acute definition of at least 5 units in 4 h. ⋯ The traditional 'massive' transfusion definition not only 'dilutes' the potential study samples with a less acute group of patients, but also further excludes patients who die early. This latter group is most likely to be benefitted from any change to resuscitation practice. An acute definition of massive transfusion should be adopted when examining clinical practice during initial trauma resuscitation.
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To determine the frequency of and primary indication for surgical airway during emergency department intubation. ⋯ In our emergency department, surgical airway is an uncommon procedure. The rate of 0.2% is significantly lower than rates quoted in other studies. The most common indication for surgical airway was severe facial or neck trauma. Our emergency department has a joint protocol for emergency intubation agreed by the Departments of Emergency Medicine, Anaesthesia and Critical Care at the Edinburgh Royal Infirmary. We believe that the low surgical airway rate is secondary to this collaborative approach. The identified low rate of emergency department surgical airway has implications for training and maintenance of skills for emergency medicine trainees and physicians.
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To evaluate the safety and effectiveness of procedural sedation with propofol by newly trained Dutch emergency physicians. ⋯ Newly trained Dutch emergency physicians can perform procedural sedation with propofol safely and effectively. Increased age and high Ramsay scores were the only risk factors for sedation events. All events were minor and responded to simple interventions.
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This report introduces and discusses the present state of the helicopter emergency medical services (HEMS) in the metropolitan area of South Korea. The data of patients transported by HEMS from April 2007 to June 2009 were provided by Seoul Metropolitan Fire and Disaster Management Department. The data of patients subsequently transported to Korea University Guro Hospital were analyzed. ⋯ No procedures other than basic life support were performed by the emergency medical technicians during transport. The role of HEMS in South Korea is limited to transporting injured patients from locations that cannot be approached by ground emergency medical services. Even though HEMS is essential considering the local mountainous geography of Seoul, Korea, overutilization of HEMS is still suspected in the metropolitan area.