Emergency medicine journal : EMJ
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ED visits have been rising year on year worldwide. It has been suggested that some of these visits could be avoided if low-acuity patients had better primary care access. This study explored patients' efforts to avoid ED presentation and alternative care sought prior to presentation. ⋯ Most low-acuity patients attempt to avoid ED presentation by seeking alternative care. This analysis identifies groups of individuals in the study region who are less likely to seek alternative care first and may benefit from targeted interventions/education. Other regions may wish to complete a similar profile to determine which patients are less likely to seek alternative care first.
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Maintaining the standard two-handed chest compression is difficult in high-speed ambulances in rural areas. ⋯ The chest compression fraction was low for patients with out-of-hospital cardiac arrest in a moving ambulance, irrespective of the number of providers. Reasons for this observation, as well as the effectiveness of the one-handed chest compression require further evaluation.
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We undertook a systematic review of all published stroke identification instruments to describe their performance characteristics when used prospectively in any clinical setting. ⋯ Available data do not allow a strong recommendation to be made about the superiority of a stroke recognition instrument. Choice of instrument depends on intended purpose, and the consequences of a false-negative or false-positive result.
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Early warning scores are frequently used in UK adult emergency departments (EDs) and are gaining traction in paediatric emergency care. Like many innovations with inherent face validity, they have great appeal to clinicians, managers and commissioners. However, it is important to ensure unintended consequences and balancing measures are mitigated. We review the background to their development and introduction in the ED, the evidence for their usefulness, their limitations in our field and areas for further research.