Journal of accident & emergency medicine
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To examine the use of thrombolytic treatment in patients with suspected acute myocardial infarction (AMI) and left bundle branch block (LBBB). To evaluate electrocardiographic criteria for the identification of AMI in the presence of LBBB, and examine the implications of using these criteria in the clinical setting. ⋯ Currently, thrombolytic treatment is under-utilised in patients with LBBB and AMI, and those who are thrombolysed endure lengthy delays before treatment. Patients with any of the predictive criteria should be thrombolysed immediately. When the diagnosis is in doubt, serial ECGs may demonstrate evolving ischaemic change.
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Clinical Trial Controlled Clinical Trial
Validation of the Ottawa ankle rules in children.
To assess whether the Ottawa ankle rules can be used to accurately predict which children with ankle and midfoot injuries need radiography. ⋯ The Ottawa ankle rules can be applied in children to determine the need for radiography in ankle and midfoot injuries. Their implementation leads to a reduction in the radiography rate without leading to an increase in the number of missed fractures.
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To determine the level of agreement between senior medical staff when asked to perform retrospective case note review of nursing triage decisions, both before and after development of a consensus approach. ⋯ Audit of nurse triage categorisation by senior medical staff performing case note review has only fair to moderate consistency between reviewers. Use of this technique will result in frustration among those whose performance is being audited if they recognise inconsistency in the standard they are compared against.
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To determine the warning time given to accident and emergency (A&E) departments by the ambulance service before arrival of a critically ill or injured patient. To determine if this could be increased by ambulance personnel alerting within five minutes of arrival at scene. ⋯ A&E departments could be alerted much earlier by the ambulance service. This would allow staff to be assembled and preparations to be made. Disadvantages may be an increased "alert rate" and wastage of staff time while waiting the ambulance arrival.