Emergency medicine journal : EMJ
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To determine whether the Emergency Department (ED) could effectively identify patients with suspected cauda equina or cord compression who warranted further investigation with MRI, and thus request MRI without prior review from neurosurgeons. ⋯ There was good correlation between ED and NS opinion on the need for MRI. Detection rate for cauda equina/severe stenosis (20.6%) was in keeping with other studies in the literature. There is significant time delay in the current referral process which can delay emergency treatment and may adversely affect patient outcome, and one patient was missed despite the proforma recommending MRI. ED doctors should request MRIs directly in the case of suspected cauda equina/cord compression . emermed;31/9/782-a/EMERMED2014204221F8F1EMERMED2014204221F8 Patient outcomes at each stage. emermed;31/9/782-a/EMERMED2014204221F9F2EMERMED2014204221F9 Outcome of MRI including detection rate of cauda equina or severe spinal stenosis. emermed;31/9/782-a/EMERMED2014204221F10F3EMERMED2014204221F10 Times between being seen by ED doctor, NS referral and MRI in all patients and patients subsequently requiring an emergency operation.
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The planning of regional emergency medical services is aided by accurate prediction of urgent ambulance journey times, but it is unclear whether it is appropriate to use Geographical Information System (GIS) products designed for general traffic. We examined the accuracy of a commercially available generic GIS package when predicting emergency ambulance journey times under different population and temporal conditions. ⋯ It is reasonable to estimate emergency ambulance journey times using generic GIS software, but in order to avoid insufficient regional ambulance provision it would be necessary to make small adjustments because of the tendency towards systematic underprediction.
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We sought to identify perceived barriers and facilitators to cardiopulmonary resuscitation (CPR) training and performing CPR among people above the age of 55 years. ⋯ We identified key facilitators and barriers for CPR training and performance in a purposive sample of individuals aged 55 years and older.
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Early recognition and treatment of sepsis in the emergency department (ED) has been shown to reduce mortality. At present, we are able to identify patients who satisfy the septic shock criteria. However, many patients admitted to the intensive care unit (ICU) do not satisfy the shock criteria whilst in the ED yet have a mortality rate of approximately 30% (unpublished internal data). The Mortality In Severe Sepsis in the Emergency Department (MISSED) score was derived and validated in ED patients admitted to the ICU. This score enables identification of patients at high risk of death. The score has now been simplified. The simplified MISSED score is made up of three independent variables which predict mortality in sepsis. They are, age >65 years, a serum albumin <27 g/l and an INR of >1.3. The score ranges from 0 to 3 depending on the number of variables present at presentation in the ED. The simplified MISSED score has been internally validated in 674 ED patients admitted in 2012. The aim of this study is to identify the mortality rate associated with the simplified MISSED score at one year from the index admission. ⋯ In patients admitted with an infection, increasing simplified MISSED scores in the ED were associated with significantly increased mortality rates at one year. emermed;31/9/784-c/EMERMED2014204221F11F1EMERMED2014204221F11 Kaplan Meier plot illustrating the one-year survival associated with the simplified MISSED score.
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Until January 2014, The National Institute of Clinical Excellence (NICE) Head Injury Guidelines (CG56) issued to clinicians advised anticoagulated patients with a head injury should only receive CT imaging if loss of consciousness or amnesia was experienced. These guidelines have recently been updated to advise CT imaging for all anticoagulated patients. We aimed to investigate how closely the 2007 guidelines were followed and whether the guideline update will mean considerable changes to existing practice. ⋯ The majority of patients that fulfilled the NICE 2007 criteria did have CT imaging performed (82%). However, a significant number of patients not fulfilling the criteria also had CT imagining performed. Overall, 60% of the anticoagulated patient cohort had CT imaging, this will need to increase considerably to follow the updated NICE 2014 guidelines of CT imaging for all patients.