Emergency medicine journal : EMJ
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Only a few cardiac-arrest victims receive external chest compression (ECC) by a bystander. ⋯ The better 'advantages over disadvantages' score for the automated ECC device over manual ECC indicated that the general public might envisage use of the device. This could contribute to increase the frequency of resuscitation attempts by bystanders.
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Effective pain management in the prehospital setting is gaining momentum as a potential key performance indicator by many emergency medical service systems, but historically has been shown to be inadequate, particularly in the paediatric population. This study aimed to identify the barriers, as perceived by a national cohort of advanced paramedics (APs), to achieving optimal prehospital management of acute pain in children. ⋯ The pathway to improving care must include an emphasis on improvements in practitioner education and training, offering alternatives to assessing pain in preverbal children, exploring the intranasal route of drug delivery in managing acute severe pain, and robustly developed evidence-based guidelines that are practitioner friendly and patient-focused.
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Observational Study
A prospective observational study of techniques to remove corneal foreign body in the emergency department.
Patients with corneal foreign bodies (CFBs) often present to the emergency department (ED). However, removal techniques vary among emergency physicians (EPs). A prospective, single-blinded, observational study was performed to compare slit-lamp-aided (SLA) versus non-slit-lamp-aided (NSLA) CFB removal by EPs. ⋯ We show that patient satisfaction ratings, complications and visual acuity were similar for the two methods. There was a trend for increased pain in the NSLA group at 12 and 24 h. Slit-lamp biomicroscopy and the use of magnification to remove CFBs remains the gold standard of care, and more intensive training should be given to EPs at the departmental level, particularly in EDs that receive patients with eye injuries.
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Clinical trials are required to strengthen the evidence base for prehospital care. This questionnaire study aimed to explore paramedics' perceptions of prehospital research and barriers to conducting prehospital clinical trials. ⋯ Paramedics reported interest and understanding of research, but a number of practical and ethical barriers were recognised that need to be addressed if prehospital clinical trials are to increase.
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Inhaled nitric oxide has been reported to benefit patients with acute pulmonary embolism (PE). To date, all published literature has derived from case reports or case series conducted without a structured protocol. Here we report the results of a phase I trial with a predefined clinical protocol to treat patients with CT-demonstrated, submassive PE and moderate to severe dyspnoea. ⋯ Inhaled NO reduced dyspnoea without adverse events in eight patients with severe submassive PE. This protocol can serve as the basis for a phase II trial or for a compassionate use protocol.