Emergency medicine journal : EMJ
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There is a lack of information available about how the skills of Foundation Doctors develop over their time spent working in the Emergency Department (ED). Knowing this could better focus future training. We wanted to examine to what extent working in the ED influences confidence of Year 2 Foundation Doctors in managing common conditions seen in the ED and in performing practical procedures. ⋯ The ED provides good exposure for improving the skills of foundation doctors. The greatest improvement was in areas doctors had not experienced elsewhere (e.g. paediatrics, suturing, diagnosing fractures).
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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.
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Massive haemorrhage still accounts for up to 40% of mortality after traumatic injury. The importance of limiting blood loss after injury in order to prevent its associated complications has led to rapid advances in the development of dressings for haemostatic control. Driven by recent military conflicts, there is increasing evidence to support their role in the civilian prehospital care environment. ⋯ Acetylated glucosamine dressings work via a combination of platelet and clotting cascade activation, agglutination of red blood cells and local vasoconstriction. Anecdotal reports strongly support the use of haemostatic dressings when bleeding cannot be controlled using pressure dressings alone; however, current research focuses on studies conducted using animal models. There is a paucity of published clinical literature that provides an evidence base for the use of one type of haemostatic dressing over another in humans.
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Medication errors are an important cause of preventable morbidity, especially in children in emergency department (ED) settings. Internal use of voluntary incident reporting (IR) is common within hospitals, with little external reporting or sharing of this information across institutions. We describe the analysis of paediatric medication events (ME) reported in 18 EDs in a paediatric research network in 2007-2008. ⋯ ME reporting by the system revealed valuable data across sites on medication categories and potential human factors. Harm was infrequently reported. Our analyses identify trends and latent systems issues, suggesting areas for future interventions to reduce paediatric ED medication errors.