Emergency medicine journal : EMJ
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Randomized Controlled Trial
Comparison of three techniques using the Parkland Formula to aid fluid resuscitation in adult burns.
We performed a randomised study to compare the accuracy and speed of three different techniques (pen and paper, electronic calculator and a novel graphic device: 'nomogram') for calculation of resuscitation fluid requirements for adults in the first 24 h of burn injury, based on the Parkland Formula. We also assessed acceptability of each technique using visual analogue scores and qualitative analysis of free text responses. 28 participants performed 252 calculations using a series of computer generated simulated patient data. For nomogram, electronic calculator, pen and paper: Magnitude of error [low (≥25%), medium (≥50%), high (≥75%)]: [6.0%, 1.2%, 0%], [17.9%, 14.3%, 8.3%], [25%, 16.7%, 9.5%]; p<0.002. ⋯ It is low cost and robust, and provides a rapid means of detecting and preventing the large errors that we have shown can occur when an electronic device is used as the only method of calculation. We therefore suggest that the Parkland Formula nomogram is a suitable method for calculation of resuscitation fluid requirements in adult burns. Fluid requirement should, however, be reviewed frequently, and adjusted to ensure adequate organ perfusion.
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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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Unplanned paediatric admissions are increasing for young children and infants experiencing respiratory illnesses. Many admissions are short-stay events, typically lasting less than 48 hrs. The short duration of these admissions could indicate that minor conditions are responsible for many of these events, and could consequently be targets for management by primary care teams. The purpose of this exploratory qualitative research is to understand more about admissions in young children attending the emergency department of a Children's hospital in the UK, with the aim of collaboratively identifying interventions to reduce admissions for minor respiratory conditions. The findings presented here will focus on the theme of clinical decision making by staff in this setting. ⋯ This research will interest educators and trainers operating in emergency paediatric settings. The emergence of 'informal learning', its acquisition and role in clinical decision making has implications in the development of training programmes for clinicians working in emergency paediatrics.
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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.
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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.