Emergency medicine journal : EMJ
-
There is limited epidemiological data for allergy Emergency Department (ED) presentations. Following recent launch of NICE guidelines and World Allergy Organisation (WAO) severity descriptions we investigated the epidemiology, management and outcomes of allergy patients presenting to a single ED. ⋯ NICE guidelines were not consistently followed but this did not seem to result in measurable short terms complications. A significant number of patients had a known precipitant.
-
Severe traumatic brain injury (TBI) in childhood causes long term neurodisability and death, though early neurosurgical intervention may improve outcome. Primary transfer to a neurosurgical centre reduces the time from initial Emergency Department arrival to performance of time critical procedures. Paediatric trauma and neurosurgery services in England have recently undergone reconfiguration. To assist pre-hospital clinicians in determining the most suitable destination for an injured child a number of trauma triage tools have been developed. We aimed to assess the performance of these tools in identifying children with severe TBI. ⋯ None of the existing paediatric pre-hospital trauma triage tools perform adequately in identifying severe TBI. Given the incidence of severe TBI in this population, and the benefits of appropriate disposition, any such tools subsequently derived should pay particular attention to their performance in regard to severe TBI with particular focus on optimising under triage rates.
-
Previous studies suggest intravenous or nebulised magnesium sulphate may improve respiratory function in patients with acute asthma. We aimed to determine whether intravenous or nebulised MgSO4 improve symptoms of breathlessness and reduce the need for hospital admission in adults with severe acute asthma. ⋯ These data suggest nebulised MgSO4 has no role in the management of severe acute asthma in adults and at best suggest only a limited role for intravenous MgSO4 in the ED.
-
Clinical assessment can be used to identify which patients with acute asthma are at risk of unsuccessful initial treatment. We aimed to determine, using data from the 3MG trial, which elements of clinical assessment predict unsuccessful treatment, defined as needing critical care or any unplanned additional treatment. ⋯ PEFR, heart rate and other serious illness are the best predictors of unsuccessful treatment, but models based on these variables provide only modest predictive value.