Emergency medicine journal : EMJ
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A short-cut review was carried out to establish whether morbidity and mortality from excited delirium syndrome (EXDS) can be predicted in the emergency department (ED). Seventy-three papers were found of which 11 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are shown in table 1. ⋯ Patients may benefit from chemical rather than physical restraint. Acidosis and hyperthermia should also be aggressively managed. Law enforcement and prehospital personnel should also be educated regarding potential complications of EXDS.
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Failure to identify eye injuries associated with facial fractures can lead to life-altering morbidity. Oral and maxillofacial surgery teams receiving referrals of patients with these injuries have a vital role in ensuring that visual acuity (VA) is recorded at the time of presentation. We present a clinical audit of documentation of VA in 126 patients who sustained orbital floor and zygoma fractures. ⋯ VA was appropriately documented in 16.5% before the session and 57.1% afterwards. This study shows that education of junior trainees gives rise to an increase in the proportion of patients where VA is properly documented. We suggest this teaching should occur routinely at junior doctor departmental inductions.
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Prehospital airway management for adult trauma patients remains controversial. We sought to review the frequency that paramedic non-drug assisted intubation or attempted intubation is performed for trauma patients in Ontario, Canada, and determine its association with mortality. ⋯ Prehospital non-drug assisted intubation for trauma is being performed less frequently in Ontario, Canada. Within our study population, paramedic non-drug assisted intubation or attempted intubation was associated with a heightened risk of mortality.