Emergency medicine journal : EMJ
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Comparative Study
The end of the line? The Visual Analogue Scale and Verbal Numerical Rating Scale as pain assessment tools in the emergency department.
To compare the Visual Analogue Scale (VAS) and the Verbal Numerical Rating Scale (VNRS), in the assessment of acute pain in the emergency department (ED). Furthermore, to determine the influence of demographics on this agreement and practical limitations of the scales. ⋯ VAS and VNRS are not interchangeable in assessing an individual patient's pain over time in the ED setting. VNRS has practical advantages over VAS in this setting.
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To establish a training course for Prehospital Focused Abdominal Sonography for Trauma (P-FAST) and to evaluate the accuracy of the participants after the course and at the trauma scene. ⋯ Following completion of a 1-day P-FAST course, participants were able to perform ultrasound procedures at the scene of an accident with a high level of accuracy.
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The Hoffa fracture is a rare unicondylar fracture of the lower femur that occurs in the coronal plane. The nature of the fracture pattern makes it both radiologically and clinically difficult to diagnose. ⋯ A high degree of suspicion is warranted to avoid missing these fractures which have a propensity to displace if not fixed. This report highlights the clinical presentation and management of a Hoffa fracture in a patient presenting with polytrauma and reviews the current literature.
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Early goal-directed therapy (EGDT) has been shown to improve outcome in patients presenting to the emergency department (ED). Uptake of EGDT in EDs in the UK has been slow. ⋯ Full delivery of EGDT by ED staff would require significant consultant support, improved training of juniors and flexibility in the 4 h target. This study suggests that it may be practical for EGDT to be initiated in the ED and that early referral to critical care will remain essential if patients are to receive the full benefit of this intervention.
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Traditionally, blunt traumatic aortic rupture (BTAR) is thought to be a high-velocity injury. It was hypothesised that BTAR has a higher than suspected incidence in low-speed accidents, with unique kinematic and demographic risk factors. ⋯ Low-impact collisions account for two thirds of fatal aortic injuries. Age >60, lateral impacts and struck side seat position are predictive of LIBTAR. Low-impact cases were associated with minor (potentially subclinical) intimomedial injuries. Therefore, it is recommended that a higher index of suspicion of aortic injury is used in low-impact scenarios in the risk groups identified.