Emergency medicine journal : EMJ
-
Paracetamol poisoning remains a major cause of morbidity and mortality. Clinical care of paracetamol poisoning depends on a range of patient variables and typically involves both medical and nursing care. An integrated care pathway (ICP) is a multidisciplinary management plan that incorporates guidelines and best practice to enhance care and documentation for a specific patient group. Paracetamol overdose is thus amenable to an ICP. ⋯ Implementation of an ICP for paracetamol poisoning significantly improved patient management and helped to standardise inter-professional decision making in this challenging patient group. This is likely to improve patient outcome.
-
To determine the causes of emergency department (ED) crowding and to identify evidence-based solutions. ⋯ While current evidence is poor, this does not justify maintaining current practice which risks lives. Building up an evidence base is critical, but requires agreed definitions, measures and methods, which can be applied to systematic evaluation of plausible solutions.
-
Acute asthma exacerbations are one of the most common reasons for paediatric emergency department visits and hospitalisations, and a relapse frequently necessitates repeat urgent care. While care plans exist, there are no acute asthma prediction rules (APRs) to assess severity and predict outcome. The primary objective of the Acute Asthma Severity Assessment Protocol study is to develop a multivariable APR for acute asthma exacerbations in paediatric patients. ⋯ Modelling of the APR will be performed once the entire sample size of 1500 has accrued. It is anticipated that the APR will improve resource utilisation in the emergency department, aid in standardisation of disease assessment and allow physician and non-physician providers to participate in earlier objective decision making. The objective of this report is to describe the study objectives and detailed methodology of the Acute Asthma Severity Assessment Protocol study.
-
Patients with symptoms of deep vein thrombosis (DVT) and pulmonary embolism (PE) commonly present to the emergency department (ED). The aim of this study was to assess the role of ischaemia-modified albumin (IMA) testing in the diagnosis of venous thromboembolism (VTE). ⋯ IMA testing cannot be used alone to diagnose DVT or PE, although there is a moderate association with PE in ED patients.
-
Sonographic assessment of jugular venous distension (US-JVD) has been described as a sensitive test for pulmonary oedema on chest x-ray in patients with dyspnoea, but chest x-ray may not detect all patients with raised B-type natriuretic peptide (BNP) levels. ⋯ US-JVD correlates with initial BNP levels and is a sensitive test for raised BNP levels in patients with dyspnoea due to suspected congestive cardiac failure.