Emergency medicine journal : EMJ
-
Comparative Study
Childhood falls: characteristics, outcome, and comparison of the Injury Severity Score and New Injury Severity Score.
The aim of this study was to determine the general characteristics of childhood falls, factors affecting on mortality, and to compare the Injury Severity Score (ISS) and the New Injury Severity Score (NISS) as predictors of mortality and length of hospital stay in childhood falls. ⋯ In our series, the head was the most frequent site of injury, and the most common type of fall was from balconies. Scores on the GCS, NISS, and ISS are significantly associated with mortality. The performance of the NISS and ISS in predicting mortality in childhood falls was similar.
-
A short cut review was carried out to establish whether loop diuretics are useful for critically ill patients with renal failure. A total of 1017 citations were reviewed of which two answered the three part question. The clinical bottom line is that in critically ill patients with acute renal failure, there is no evidence to suggest that the use of loop diuretics reduces mortality, reduces length of ITU/hospital stay, or increases the recovery of renal function.
-
The aim of monitoring patients is to detect organ dysfunction and guide the restoration and maintenance of tissue oxygen delivery. Monitoring is a crucial part of the care of the critically ill patient in the emergency department as the physiological response to critical illness is linked strongly to outcome. ⋯ End tidal carbon dioxide monitoring, pulse oximetry, arterial blood pressure monitoring, central venous pressure monitoring, continuous central venous oxygenation saturation monitoring, temperature monitoring, and urine output are discussed. Practitioners should be familiar with the physiology and technology underlying these monitoring techniques and be aware of the pitfalls in interpretation of monitored data.
-
To determine the scale of acute neurosurgery for severe traumatic brain injury (TBI) in childhood, and whether surgical evacuation for haematoma is achieved within four hours of presentation to an emergency department. ⋯ The system of care for severely head injured children in the UK does not achieve surgical evacuation of a significant haematoma within four hours. The recommendation to use specialist regional paediatric transfer teams delays rather than expedites the emergency service.
-
Ireland's health services are undergoing dramatic reorganisation. The establishment of general practitioner (GP) out of hours cooperatives and the integration of current ambulance services into a national ambulance service are among the issues that will impact on prehospital care of emergencies. The study aimed to explore the perceptions of GPs and emergency medical technicians (EMTs) of their own and each other's roles in the context of such reforms. ⋯ Convergence between the professional groups in different geographic areas and between the disciplines across the areas is striking. They include areas of satisfaction and dissatisfaction. The need for improved liaison between the disciplines is clear.