Emergency medicine journal : EMJ
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Randomized Controlled Trial
Comparison of clinical outcomes between intermittent and continuous monitoring of central venous oxygen saturation (ScvO2) in patients with severe sepsis and septic shock: a pilot study.
The Surviving Sepsis Campaign (SSC) to improve patient outcomes in severe sepsis and septic shock contains recommendations for protocolised resuscitation including early goal-directed therapy (EGDT) resuscitation. In EGDT, central venous oxygen saturation (ScvO2) is measured as the target monitoring value. The objective of this study was to determine whether intermittent measurement of ScvO2 is as clinically effective as continuous monitoring in EGDT implementation. ⋯ During EGDT, intermittent ScvO2 monitoring was not inferior to continuous ScvO2 monitoring when delivered within the first 6 h of intervention.
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Occupational, social and recreational routines follow temporal patterns, as does the onset of certain acute medical diseases and injuries. It is not known if the temporal nature of injury and disease transfers into patterns that can be observed in ambulance demand. This review examines eligible study findings that reported temporal (time of day, day of week and seasonal) patterns in ambulance demand. ⋯ Temporal patterns are present in ambulance demand and importantly these populations are distinct from those found in hospital datasets suggesting that variation in ambulance demand should not be inferred from hospital data alone. Case types seem to have similar temporal patterns across jurisdictions; thus, research where demand is broken down into case types would be generalisable to many ambulance services. This type of research can lead to improvements in ambulance service deliverables.
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The authors report a case of a 10-year-old boy who presented to the emergency department following an episode of syncope. While on telemetry, the child was found to have runs biventricular tachycardia. Catecholaminergic polymorphic ventricular tachycardia was diagnosed, and the case report discusses this rare but important diagnosis that should be considered in children presenting with syncope.
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Patients with suspected acute myocardial infarction (AMI) and stroke commonly present first to the ambulance service. Little is known about experiences of prehospital care which are important for measuring the quality of services for patients with AMI or stroke. ⋯ Factors that contribute to better patient experience are not necessarily understood in the same way by patients and clinicians. Our findings can contribute to the development of patient experience measures for prehospital care.