European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Among all prehospital emergency intubations, difficulties occur in 7-10%. Furthermore, intubation conditions often worsen when the cervical spine is immobilized in trauma patients. ⋯ Endotracheal intubation with the Bonfils intubation fiberscope was successful in all cases in the first attempt. The Bonfils intubation fiberscope therefore demonstrated its value as an additional airway management device in both emergency and prehospital settings.
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To assess the accuracy of Senior House Officers at interpreting plain X-rays following their triage by radiographers in an emergency department. ⋯ Currently, the Senior House Officer contributes to the red dot system by improving on the radiographer in rates of diagnosis of both abnormal and normal X-rays. Further reductions in error rates, however, are unlikely to be achieved until there is a change to the existing system. This may ultimately involve removing some of the responsibility of X-ray interpretation from the Senior House Officer. Any future research should consider the methodological issues highlighted by this study.
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Cardiac contusion following blunt chest trauma is not rare, and the works in the literature report incidence rates between 5 and 50%. Traffic accidents are the most frequent cause of cardiac contusion followed by violent fall impacts, aggressions and the practice of risky sports. The spectrum of post-traumatic cardiac lesions varies greatly, ranging from no symptoms to decrease in cardiac function. ⋯ We review our experience of cardiac contusion after blunt chest trauma, and we describe two very severe cases that manifested as cardiogenic shock. We emphasize an early diagnosis by continuous electrocardiographic monitoring, serial electrocardiograms, echocardiography, serum determination of biochemical cardiac markers, radionuclide imaging and coronary angiography. The treatment includes continuous monitoring of cardiac rhythm, use of inotropic drugs, insertion of a catheter in the pulmonary artery for continuous assessment of cardiac output and, in extreme cases, the insertion of a contrapulsation balloon to maintain haemodynamics until improvement of cardiac function.
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The aim of the study was to assess the immediate and long-term effect of a helicopter emergency physician giving advanced life support on-scene compared with conventional load and go principle in urban and rural settings in treating blunt trauma patients. ⋯ The physicians treated the patients more aggressively, but it did not delay the arrival at the hospital. A beneficial effect of this aggressive treatment or direct transport to a university hospital could not be seen in the immediate physiological parameters or later health-related quality of life. The physician-staffed helicopter emergency medical service was not beneficial to blunt trauma patients in this setting.
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Controlled Clinical Trial
Avoiding prolonged waiting time during busy periods in the emergency department: Is there a role for the senior emergency physician in triage?
Patient satisfaction at emergency departments can be improved by reductions in waiting time. Traditional methods require registration and triage before seeing the doctor with senior emergency physicians mainly engaged in treating serious cases. We examine a radical change in workflow pattern on waiting time by placing a senior emergency physician with the triage nurse and examining the impact of treating simple cases upfront with discharge on the waiting times for stretcher cases. ⋯ Placing a senior emergency physician with the triage nurse reduced waiting times for walk-in cases. One third of attendances were treated and discharged quickly, allowing the consulting room and PACS 1/PACS 2 doctors to act more efficiently.