Emergency medicine journal : EMJ
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Use of specialist healthcare services is increasing. ⋯ The use of specialist care hospital admission can be reduced if appropriate alternatives are available.
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Multicenter Study
Violence in the emergency department: a multicentre survey of nurses' perceptions in Nigeria.
Emergency department (ED) violence is common and widespread. ED staff receive both verbal and physical abuse, with ED nurses bearing the brunt of this violence. The violence is becoming increasingly common and lethal and many institutions are still improperly prepared to deal with it. ⋯ There is a need to make the EDs safer for all users. This can be achieved by a deliberate management policy of 'zero' tolerance to workplace violence, effective reporting systems, adequate security and staff training on prevention of violence.
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To predict the outcome of stroke at an acute stage is important but still difficult. Vomiting is one of the commonest symptoms in stroke patients. The aim of this study is threefold: first, to examine the percentage of vomiting in each of the three major categories of strokes; second, to investigate the association between vomiting and other characteristics and third, to determine the correlation between vomiting and mortality. ⋯ Compared with patients without vomiting, the risk of death was significantly higher in patients with vomiting at the onset of stroke. Vomiting should be an early predictor of the outcome.
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Abuse in Emergency Department (ED) as a widespread phenomenon, has negative effects on ED residents. This issue pertains to Western as well as Asian countries. ⋯ Being abused during residency is a universal problem, and there is a lack of awareness and the knowledge of how to deal with abuse, and reporting it among ED residents in Iranian hospitals.
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The emergency care of patients who may have spinal injuries has become highly ritualised. There is little scientific support for many of the recommended interventions and there is evidence that at least some methods now used in the field and emergency department are harmful. Since prospective clinical trials are not likely to resolve these issues I propose a reconceptualisation of spinal trauma to allow a more rational approach to treatment. ⋯ I then develop a list of recommended treatment variations that are more in keeping with the actual causes of post impact neurological deterioration than are current methods. Discarding the fundamentally flawed emphasis on decreasing post injury motion and concentrating on efforts to minimise energy deposition to the injured site, while minimising treatment delays, can simplify and streamline care without subjecting patients to procedures that are not useful and potentially harmful. Specific treatments that are irrational and which can be safely discarded include the use of backboards for transportation, cervical collar use except in specific injury types, immobilisation of ambulatory patients on backboards, prolonged attempts to stabilise the spine during extrication, mechanical immobilisation of uncooperative or seizing patients and forceful in line stabilisation during airway management.