Emergency medicine journal : EMJ
-
Randomized Controlled Trial Multicenter Study
Clinical effects and safety of different strategies for administering intravenous diuretics in acutely decompensated heart failure: a randomised clinical trial.
The mainstay of treatment for acutely decompensated heart failure (ADHF) is intravenous diuretic therapy either as a bolus or via continuous infusion. ⋯ In patients with ADHF attending the ED, boluses of furosemide have a smaller diuretic effect but provide similar clinical relief, similar preservation of renal function, and a lower incidence of hypokalaemia than continuous infusion.
-
In most countries, road traffic collisions (RTCs) are the main cause of cervical spine injuries. There are several techniques in use for spinal immobilisation during prehospital extrication; however, the evidence for these is currently poor. ⋯ Conventional extrication techniques record up to four times more cervical spine movement during extrication than controlled self-extrication. This proof of concept study demonstrates the need for further evaluation of current rescue techniques and the requirement to investigate the clinical and operational significance of such movement.
-
SIGN guideline 111 makes recommendations on the optimal management of patients with a hip fracture.(1) It is clear from the use of care bundles in other conditions, eg sepsis, that these perform very well in time-critical settings and ensure that all necessary actions for person-centred care are achieved timeously. Given the success of our Emergency Department (ED) compliance with the Sepsis 6 bundle (100%-unpublished data) the principal author (JK) rationalised that a bundle applied to the SIGN hip fracture recommendations would ensure that all actions were achieved in a timely manner. ⋯ Although fractures of the neck of femur do not necessarily result in the physiological derangement associated with sepsis, it is evident that the use of a bundle of care will ensure that hip fracture patients are managed in a timely, person-centred and safe fashion as recommended in SIGN 111. Future work will concentrate on improving compliance with all seven actions within one hour of patient attendance.
-
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.