Emergency medicine journal : EMJ
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Multicenter Study
The evolution of the emergency care practitioner role in England: experiences and impact.
The emergency care practitioner (ECP) is a generic practitioner who combines extended nursing and paramedic skills. The "new" role emerged out of changing workforce initiatives intended to improve staff career opportunities in the National Health Service and ensure that patients' health needs are assessed appropriately. ⋯ Indications are that the ECP schemes are moving forward in line with original objectives and could be having a significant impact on the emergency services workload.
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To evaluate the introduction of a focussed assessment with sonography in trauma (FAST) scan into the early assessment of trauma patients in the UK. ⋯ FAST is a highly specific "rule in" technique and is useful in the initial assessment of trauma patients. Emergency physicians can perform FAST after a brief training period.
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A significant number of emergency department (ED) patients in Japan may be affected by mental health problems leading to attempted suicide. This retrospective descriptive study aimed to explore mental health service needs in a Japanese medical centre ED. ⋯ Approximately 38% (95% CI 35.8 to 39.9) of patients presenting to an ED could be affected by mental health problems.
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There is no specific antidote for the treatment of casualties exposed to chlorine, phosgene, or mustards; therefore, management is largely supportive. Corticosteroid treatment has been given to casualties accidentally exposed to chlorine. Clinical data on efficacy are inconclusive as the numbers given steroids have been small and the indications for administration unclear. ⋯ Lung injury induced by phosgene and mustard appears to be mediated by glutathione depletion, lipid peroxidation, free radical generation, and subsequent cellular toxicity. There is limited evidence to suggest that repletion of glutathione reduces and/or prevents lung damage by these agents. This may provide an opportunity for therapeutic intervention.
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Vibrio vulnificus is a Gram-negative marine bacterium that may cause local wound infection, gastroenteritis, or septicaemia. Fatal septicaemia usually presents with fever, shock, and large haemorrhagic bullae on the legs. This report is about a man who had severe V. vulnificus septicaemia but presented with atypical features of leg pain and diffuse purpuric skin lesions. V. vulnificus septicaemia should be suspected if the following are present: septic shock, leg pains associated with diffuse purpuric skin lesions, recent consumption of raw seafood, and a past medical history of liver cirrhosis.