Emergency medicine journal : EMJ
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Adverse drug reactions (ADR) cause considerable morbidity and mortality. ⋯ This study estimated the incidence of ADR-related admissions to an Irish hospital at 8.8%, with 57.3% of these deemed to have been potentially avoidable. Older patients were more likely to have an ADR-related admission. Prescribers must be aware of this increased likelihood of an ADR when prescribing new drugs to this patient population, and regularly review treatment.
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A short-cut review was carried out to establish whether the pulmonary embolism rule-out criteria (PERC) can safely exclude the diagnosis of pulmonary embolism (PE) in the emergency department (ED). One recent systematic review was directly relevant to the question and incorporated all the other relevant evidence identified. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in table 3. The clinical bottom line is that PERC may be safely applied to patients aged 18-49 years presenting to the ED with chest pain and/or dyspnoea providing that the pre-test probability of PE is 7% or less (equivalent to a Wells score of <2).
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Ambulance workers are regularly exposed to call-outs, which are potentially psychologically traumatic. The ability to remain objective and make adaptive appraisals during call-outs may be beneficial to this at-risk population. This pilot study investigated the links between cognitive appraisals, objectivity and coping in ambulance workers. ⋯ Ambulance workers may benefit from psychological interventions, which focus on cognitive reappraisal and enhancing objectivity to improve coping and resilience.
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This paper describes the first 16-months experience of prehospital rapid sequence intubation (RSI) in a rural and suburban helicopter-based doctor-paramedic service after the introduction of a standard operating procedure (SOP) already proven in an urban trauma environment. ⋯ We have demonstrated the successful introduction of a prehospital care SOP, already tested in the urban trauma environment, to a rural and suburban air ambulance service operating a fulltime doctor-paramedic model. We have shown a zero failed intubation rate over 16 months of practice during which time over 750 missions were flown, with 11.5% of these resulting in an RSI.
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Validation of the classification of hypovolaemic shock suggested by the prehospital trauma life support (PHTLS) in its sixth student course manual. ⋯ The PHTLS classification of hypovolaemic shock displays substantial deficits in adequately risk-stratifying trauma patients.