Emergency medicine journal : EMJ
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A short cut review was carried out to establish whether testing for troponin levels is useful after discharge of an Implanted Cardioverter-Defibrillator (ICD). Many papers were found using the reported searches, none of which directly addressed the problem but some 13 presented the best evidence to answer the clinical question. ⋯ It is concluded that the number of ICD discharges must be taken into account when evaluating any troponin level rise. Overall a positive troponin assay post ICD discharge is independently associated with an increased mortality.
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A short cut review was carried out to establish whether routine nasogastric decompression with a nasogastric tube improved the process and outcome of care in adults with small bowel occlusion. 211 papers were found using the reported searches, of which 1 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 this paper is tabulated. It is concluded that there is no scientific evidence for the routine use of nasogastric tubes in these patients.
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A helicopter emergency medical service (HEMS) capable of winching offers several advantages over standard rescue operations. Little is known about the benefit of physician winching in addition to a highly trained paramedic. ⋯ Our high POI rate of 40% (48/120) coupled with long rescue times and the occasional severe injuries support the argument for winching Physicians. Not doing so would deny a significant proportion of patients time-critical interventions, advanced analgesia and procedural sedation.
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Comparative Study
Comparison of resident and mid-level provider productivity in a high-acuity emergency department setting.
Mid-level providers (MLPs) are used in many emergency departments (EDs) to provide care in a low-acuity, high-volume setting, and are able to see more patients and generate more relative value units (RVUs) than residents in this setting. It is unknown if MLPs are as productive as emergency medicine residents in a high-acuity setting. ⋯ In a high-acuity area of the ED, MLPs see more patients per hour than residents, but generate fewer RVUs per patient. This suggests that residents may document more thoroughly than MLPs. Alternatively, MLPs may elect to see less sick patients even when working in a high-acuity area.
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In the Netherlands, screening for child maltreatment is mandatory in all emergency departments but it is unclear which screening methods are being used. As a first step towards implementation of a universal screening method across all emergency departments, we assessed the currently used screening methods. ⋯ Large variations in screening methods exist across emergency departments in the Netherlands, most of which are not based on empirical evidence.