Emergency medicine journal : EMJ
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Pre-hospital triage is becoming increasingly important as Regional Trauma Networks for children are implemented in England. The low incidence of trauma in children makes pre-hospital assessment of injury severity and where to send an injured child challenging. Currently there are few validated pre-hospital triage tools for children's trauma and no consensus on which to use. We investigate performance characteristics of pre-hospital paediatric triage tools currently in use in England for identifying injured children. ⋯ From TARN data, two triage tools demonstrated acceptable under-triage rates (3% and 4%) for severe injuries but unacceptable over-triage of moderate injuries (83% and 72%). Two tools demonstrated acceptable over-triage (7% and 16%) with unacceptable under-triage (61% and 63%). Four tools demonstrated unacceptable under- and over-triage. For moderate and minor injuries, three tools demonstrated acceptable under- and over-triage rates (all 0%). The other five tools had unacceptable under-triage rates (25-100%). All eight tools had acceptable over-triage rates (1%-21%). (See tables 1 and 2) Abstract 004 Table 1Performance characteristics of pre-hospital paediatric trauma triage tools-TARN/severe injuries ToolnISS>15Undertriage rate (%)Overtriage rate (%)East Midlands701230383London472North West780Northern977South West London; Surrey1259Wessex3923Paediatric Trauma Score617Paediatric Triage Tape283946316 Abstract 004 Table 2Performance characteristics of pre-hospital paediatric trauma triage tools-Moderate/minor injuries ToolnISS>15Undertriage (%)Overtriage (%)East Midlands29344018London2511North West021Northern019South West London; Surrey509Wessex507Paediatric Trauma Score1001Paediatric Triage Tape18114753 CONCLUSION: For severe injuries, none of the pre-hospital triage tools for injured children currently used in England meet recommended criteria for over- and under-triage rates. For moderate to minor injuries, all tools achieved acceptable over-triage rates but tended to under-triage. There is an urgent need for development of triage tools to accurately risk-stratify injured children in the pre-hospital setting.
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We sought to quantify knowledge and attitudes regarding automated external defibrillators (AEDs) and cardiopulmonary resuscitation (CPR) among university students. We also aimed to determine awareness of the location of an actual AED on campus. ⋯ This study found that most students at an American university can identify CPR and AEDs, but do not understand their basic mechanisms of action or are willing to perform CPR or use AEDs unassisted. Recent CPR/AED training and 9-1-1 assistance increases comfort. The most common fear reported was incorrect CPR or AED use. Almost all students could not recall where an AED was located in a student centre.
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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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Subgaleal haematoma is associated with skull fracture in infants and young children. If the onset is reported to have appeared some time after the suggested mechanism, history may be placed in doubt raising safeguarding concerns. This can lead to social care intervention driven by medical opinion. We performed this study to evaluate our hypothesis that delay in haematoma is common in simple accidental head trauma. ⋯ Whilst every case of skull fracture in infants and young children must be thoroughly assessed for safeguarding concerns, our findings suggest that delayed onset of a subgaleal haematoma can be consistent with accidental injury. It is important to take this into account when offering medical opinion on such cases, to avoid unnecessary social care and legal intervention.
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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).