Emergency medicine journal : EMJ
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Since 'legal highs' emerged as drugs of abuse in the UK, Emergency Physicians have battled to keep up with the latest drug craze. Whilst many of these drugs present with recognisable toxidromes, the effect of new compounds or medications cannot be readily predicted. In Belfast, we have witnessed a recent increase in the number of patients presenting after recreational abuse of Pregabalin (Lyrica). Patients, state that the medication induces a state similar to drunkenness, hence the street name 'Budweiser's'. To our knowledge this is the first case series detailing the recreational abuse of Pregabalin, a drug which has become popular in primary care. ⋯ Emergency Physicians should be aware of the current use of Pregabalin as a recreational drug. Patients are either taking tablets whole or cutting and snorting them. 60% of patients in this case series presented to the ED with seizures and 20% required ICU admission. We recommend that patients who present with potential Lyrica toxicity should be admitted for observation with the treating physician being mindful of the potential for seizure activity.
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Appropriate activation of multi-disciplinary trauma teams improves outcome for severely injured patients, but can disrupt normal service in the rest of the hospital. Derriford Hospital uses a two-tiered trauma team activation system. The emergency department (ED) trauma team is activated in response to a significant traumatic mechanism; the hospital trauma team is activated when this mechanism co-exists with physiological abnormality or specific anatomical injury. The aim of this study was to compare characteristics, process measures and outcomes between patients treated by ED or hospital trauma teams to evaluate the approach in a UK setting and to estimate any cost savings involved. Figure 1 outlines the composition and activation criteria of the teams. Abstract 014 Figure 1(a) ED trauma team activation and (b) Hospital trauma team activation. ⋯ A two-tiered trauma team activation system is an efficient, safe and cost-effective way of dealing with trauma patients presenting to a Major Trauma Centre in the UK.
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Patients with dementia and traumatic injury require prompt and adequate pain relief. However we hypothesised that they may be at risk of under-treatment with analgesia in the emergency setting. ⋯ Our findings suggest that injured patients with dementia are less likely to receive timely analgesia in the ED than patients without dementia. Further work is needed to identify the reasons behind this inequity and intervene accordingly. Abstract 022 Figure 1Kaplan-Meier plot of time interval from ED arrival to first analgesic; patients with dementia (upper curve) vs. controls (lower curve); p=0.074.
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International guidance has recently recommended serial proximal compression ultrasound (CUS) as first line imaging for suspected deep vein thrombosis (DVT). Limitations with this strategy include attrition, lack of a clear diagnosis, and increased costs associated with serial resource use / clinical review. Single whole-leg CUS is a routine alternative diagnostic strategy that can reduce repeat attendance and identify alternative pathology. We sought to assess the performance characteristics of an established emergency department ambulatory protocol incorporating whole-leg CUS by non-physicians for exclusion of DVT. ⋯ Patients who have anticoagulation withheld following a negative or inconclusive whole leg CUS for suspected DVT have a low rate of adverse events at 3 months. Including the calf in ultrasound examination aided and clarified diagnosis in approximately one third of patients. Technical failure remains an issue: several factors were significantly associated with inconclusive results in our cohort and may warrant an alternative diagnostic approach Abstract 008 Table 1Measuring ED crowding Measure Operational DefinitionAbility of ambulances to offload patients.An ED is crowded when the 90th percentile time between ambulance arrival and offload is greater than 15 minutesPatients who leave without being seen or treated (LWBS)An ED is crowded when the number of patients who LWBS is greater than or equal to 5%.Time until TriageAn ED is crowded when there is a delay greater than 5 minutes from patient arrival to begin their initial triage.ED occupancy rate.An ED is crowded when the occupancy rate is greater than 100%.Patients' total length of stay in the EDAn ED is crowded when the 90th percentile patient's, total length of stay is greater than 4 hours.Time until a physician first sees the patientAn ED is crowded when an emergent (1 or 2) patient waits longer than 30 minutes to be seen by a physicianED boarding timeAn ED is crowded when less than 90% of patients have left the ED 2 hour after the admission decision.Number of patients boarding in the ED.Boarders are defined as admitted patients waiting to be placed in an inpatient bed. An ED is crowded when there is greater than 10% occupancy of boarders in the ED ED; Emergency Department Abstract 008 Table 2Performance of the ICMED against clinician perception of crowding Sensitivity (95% CI)Specificity (95% CI)Ambulance Offload55.9 (45.3-66.5)90.0 (83.6-96.4)Nurse Triage70.6 (60.8-80.3)76.0 (66.9-85.1)Occupancy55.9 (45.3-66.5)78.0 (69.1-86.9)Total stay55.9 (45.3-66.5)100.0 (88.8-100)ED Boarding Time55.9 (45.3-66.5)100.0 (88.8-100)Time to see a Physician32.4 (22.4-42.4)84.0 (76.2-91.8)Patients Boarding85.3 (77.7-92.9)70.0 (60.2-79.8)One Violation100.0 (89.7-100)38.0 (27.6-48.4)Two Violations100.0 (89.7-100)60.0 (49.5-70.5)Three Violations91.2 (85.1-97.2)100.0 (92.9-100)Four Violations50.0 (39.3-60.7)100.0 (88.8-100)Five Violations26.5 (17.0-35.9)100.0 (88.8-100)Six Violations23.5 (14.5-32.6)100.0 (88.8-100)Seven Violations8.8 (2.8-14.9)100.0 (88.8-100).
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Formative assessments support learning. Ideally then, such trainee/ trainer interaction would occur throughout the training year and include cases that are stretching. In this way areas for trainee development could be identified and a training plan refined and executed. Such an approach would give time to revisit themes with further assessments towards the end of the year. ⋯ There is a high rate of excellence recorded is assessments, and around half of assessments are performed at the end of the academic year. There were more assessments performed in the month of ARCP (June) than in the first 5 months of the academic year. Future iterations of the assessment schedule will include means of ensuring trainee/trainer interaction is scheduled throughout the year and includes a case mix that stretches the trainee with trainer support.