Emergency medicine journal : EMJ
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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.
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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.
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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.
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Timely defibrillation and high-quality cardiopulmonary resuscitation (CPR) are the only pre-hospital interventions which have been demonstrated to save lives after OHCA (out-of-hospital cardiac arrest). Standard resuscitation using the advanced life support (ALS) algorithm specifies a period of two minutes of CPR after delivering a shock before re-assessing the rhythm and delivering a further shock if indicated. Recent work has focused on improving quality of CPR, but few studies have examined how effectively defibrillation is carried out in pre-hospital practice. This study aims to assess the timing of shocks during resuscitation after OHCA. ⋯ There were 189 cardiac arrests in the study period, with 70 cases eligible for inclusion. Mean time between shocks was 3:06 min (0:15 min-18:23 min, SD 1:54 min). 53% of inter-shock intervals were >2:30 min and 21% were <2:00 min. Only 26% of intervals were compliant with ALS guidelines. Figure 1 shows a scatter plot of the inter-shock intervals for each OHCA resuscitation episode. The red bar indicates the 'compliant' zone of 2:00-2:30 min. emermed;31/9/781-b/EMERMED2014204221F7F1EMERMED2014204221F7 CONCLUSION: The majority of intervals between shocks delivered in out-of-hospital cardiac arrest were non-compliant with current ALS guidelines. Whilst the underlying reasons for this finding remain unclear, the extreme outliers appeared to be related to transporting the patient from the scene of the arrest. It was still the case, however, that the majority of defibrillation attempts were delivered either earlier than 2 min or later than 2:30 min, which may reflect a loss of situational awareness in the distracting environment of an OHCA resuscitation. Further work needs to be done to establish the cause of this deviation from recommended shock timing in order to develop strategies to optimise practice.
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Traumatic cardiac arrest (TCA) in children is associated with poor survival (<5% in the majority of studies) and even worse neurological outcome.Since 2003, over 600 seriously injured local national children have been treated at deployed UK military medical treatment facilities during the Iraq and Afghanistan conflicts. A number of these were in cardiac arrest after sustaining traumatic injuries.emermed;31/9/790-a/SA2EMERMED2014204221TB7T1sa2-EMERMED2014204221TB7 Mechanism of InjuryMechanismIED13GSW7MVC4Drowning4Other (RPG, UXO)4Total32Trauma care has continually advanced during the recent conflicts, leading to many unexpected survivors (1). The objective of this study was to define outcomes from paediatric TCA in this cohort. ⋯ Outcomes from this cohort show better survival rates in paediatric traumatic cardiac arrest compared to the most other studies. The reason for this is not known, although this mirrors the unexpected survivors previously reported in recent military series. Further work is necessary to define the optimal management of paediatric patients in TCA.