Emergency medicine journal : EMJ
-
To measure the sensitivity of modern CT in patients presenting to the emergency department and evaluated for possible subarachnoid haemorrhage, with particular attention to those presenting within 12 h of ictus. ⋯ While modern CT has a high sensitivity for the diagnosis of acute subarachnoid haemorrhage, particularly within 12 h of ictus, it is still not sufficient to act as the sole diagnostic tool, and patients with a negative CT will require further investigation with a lumbar puncture.
-
To compare oral prednisolone with oral indomethacin in patients presenting to emergency departments (ED) with acute gout firstly for analgesic effectiveness, and secondly for safety. ⋯ Prednisolone and Indomethacin are equally effective first line treatments for acute gout in ED patients. There were no serious adverse event rates during a follow-up period of 14 days.
-
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care unit (ICU) do not satisfy the shock criteria whilst in the ED yet have a mortality rate of approximately 30% (unpublished internal data).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.
-
EM and Paediatrics are specialties at the forefront of the move towards 24/7 consultant delivered care. This shift has been partly driven in EM by trauma pathways, as well as aiming to provide better patient care, and to support training.Chelsea and Westminster Paediatric ED sees around 34,000 children a year. It is not a major trauma centre. In May 2013, 6 consultant paediatricians were appointed to be resident in PED at night. This study evaluates the PED team's perceptions of the impact of this change on the quality of clinical care, training and job satisfaction, and of trainee's views of undertaking a similar role in the future. ⋯ PED staff at C&W have welcomed the move to 24/7 consultant delivered care. The core aims - to improve the efficiency and proficiency of patient care, and to better utilise out of hours working as a training opportunity - are being achieved. Concerns remain about disempowerment of senior trainees and the perceived impact of night shifts in a consultant role on work-life balance. To sustain this model, trainees must be convinced of the benefits of becoming a resident consultant upon their own career.
-
In the past nine years, the number of patients attending the A&E department of the Royal Victoria Hospital Belfast, with neurological complaints has more than doubled.The number of A&E attendees with neurological complaints is similar to cardiology and higher than gastroenterological complaints. Approximately half of attendees were referred for further investigations or specialist opinion via their primary care physician. Of all attendees only a small number (29%) were referred to or discussed with the neurology department.More than half of A&E attendees presenting with neurological complaints are admitted, mostly under medical team (95%). The number of patients admitted with neurological complaints is higher than for gastroenterology or cardiology. ⋯ The results of the pilot study suggest that provision of a RANC can reduce unnecessary hospital admissions for patients with neurological complaints. The pilot study received very positive feedback from A&E colleagues and patients. Regular provision of the service may lead to considerable cost savings.emermed;31/9/779-b/SA32EMERMED2014204221TB1T1sa32-EMERMED2014204221TB1Compare time period with and without RANC01/08/13-31/08/13RANC not in place25/09/13-23/10/13RANC in placeA+E attendees71496849Neurology patients479436Admitted269211% admitted56.2%48.4%Referred to RANC048Admission avoided028If no RANC availableAdmission rate56.2%54.8%emermed;31/9/779-b/SA32EMERMED2014204221TB2T2sa32-EMERMED2014204221TB2A and E attendances in last 9 years in RVH by medical specialityYearCardGastroNeuroResp200527211747237124652006235917692292248020072831182225202908200825982247254031502009295920102836328820103103220930503362201133142629363635842012488234014419550420134966383950635714emermed;31/9/779-b/EMERMED2014204221F15F1EMERMED2014204221F15RVH A&E attendances by speciality since 2005emermed;31/9/779-b/EMERMED2014204221F16F2EMERMED2014204221F16Neurological symptoms seen in the RANC.