Emergency medicine journal : EMJ
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This study was conducted to break the door-to-balloon time (DTBT) into constituent elements, and compared which components prolonged markedly. We identified the factors that significantly prolonged the DTBT in an underdeveloped area of China. ⋯ In our centre, the time of consultation by the cardiologists and explaining the patient's condition to the family accounted for most of the delay in reperfusion. A lack of interventionists usually resulted in a delay during non-working hours in the CL. Several measures should be taken involving asking emergency department physicians to awake CL directly, sending the patients' information to the cardiologists, popularising medical knowledge to the citizens, and increasing the numbers of interventionists qualified to carry out primary percutaneous coronary intervention, should be developed to shorten the DTBT.
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Previous research suggests individuals who suffer from cognitive impairment are less able to vocalise pain than the rest of the cognitively-intact population. This feature of cognitive impairment may be leading to a chronic underdetection of pain as current assessment tools strongly rely on the participation of the patient. To explore inconsistencies in pain management within the acute setting, we conducted a retrospective assessment of 224 patients presenting with fractured neck of femur at a large teaching hospital's accident and emergency (A&E) department between 2 June 2011 and 2 June 2012. ⋯ The cognitively-impaired cohort would also wait on average an hour longer before receiving this initial pain relief. We believe that these differences stem from cognitively-impaired patients being unable to vocalise their pain through traditional assessment methods. This work discusses the potential development or adoption of a tool which can be applied in the acute setting and relies less on vocalisation but more on the objective features of pain, so making it applicable to cognitively-impaired individuals.
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In the West Midlands region of the UK, the delivery of prehospital trauma care has recently been remodelled through the introduction of a regionalised major trauma network (MTN). Helicopter emergency medical services (HEMS) are integral to the network, providing means of delivering highly skilled specialist teams to scenes of trauma and rapid transfer of patients to major trauma centres. This study reviews the impact of introducing the West Midlands MTN on the operation of one its regional HEMS units. ⋯ Since the introduction of the West Midlands MTN, tasking of HEMS assets appears to be better targeted to cases involving significant injury, and a reduction in mission cancellations has been observed. There is a need for more detailed evaluation of patient outcomes to identify strategies for optimising the utilisation of HEMS assets within the regional network.
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This study evaluated several aspects of patients' and providers' knowledge and attitude regarding emergency CT scan use. Specifically, is patient awareness of radiation risks changing over time and do levels of education affect this knowledge? Meanwhile, do emergency medicine providers discuss risks with patients and do patients want to know about these risks? ⋯ ED patient knowledge has increased significantly over the past 8 years. At the same time, there is a trend towards ED providers more commonly discussing these risks. Level of education is associated with knowledge that CT uses x-rays, but not with knowledge that this is associated with a greater risk of cancer. Patients often want to be informed of these risks.
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The influence of high blood alcohol level (BAL) on the outcome of severely injured patients and the corresponding pathophysiological changes is a controversial issue. ⋯ Severely injured patients with a raised BAL have a higher incidence of severe traumatic brain injury and worse initial physiological parameters. However, the survival rate and in-hospital stay is not influenced. This supports the theory of a neuroprotective role of alcohol.