Emergency medicine journal : EMJ
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A 'whole body' or 'pan-scan' computed tomography (CT) imaging approach is now becoming the standard of care during the early management of adult patients with suspected severe blunt multitrauma. A number of studies have variously reported a mortality benefit or no benefit from a pan-scan approach compared to that of carrying out body region-focused CT and/or plain radiographs or a mixture of imaging modalities. However, unanswered questions still remain due to the significant heterogeneity in practice between institutions, and the limitations of published studies. The potential risk for harm from ionising radiation or intravenous contrast-induced nephropathy is still a concern, especially where mortality benefit from an unselective pan-scan approach is yet to be definitively proven.We present the results of our latest analysis of the Trauma Audit and Research Network (TARN) database; updated to take into account the establishment of the regional trauma network system and focusing on the Major Trauma Centre's (MTC's). ⋯ The results of our investigation demonstrate that there is no risk adjusted mortality benefit observed from current practice in MTCs in England and Wales. Key issues remain to be addressed such as pan-scan selection criteria and the significant heterogeneity observed in practice across institutions.
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Multicenter Study Observational Study
5 A study analysing the diagnostic performance of ECG interpretation for 30-day major cardiac events in the emergency department.
This study evaluates the diagnostic accuracy of an Emergency Medicine (EM) clinician at identifying ischaemia on an ECG using 30-day major adverse cardiac events (MACE) as the primary outcome. ⋯ This is the first prospective, multi-centre cohort study, that assess the diagnostic performance of EM clinician's ECG interpretation, with 30-day MACE as the primary outcome. The findings are highly relevant to EM as they represent the ECG terms used by popular acute coronary syndrome clinical decision rules. In this study a clinician's overall judgement of ischaemia has a better diagnostic performance compared to simple STD and ATWI. This may be due to an appreciation of morphology and the amount of deviation; future work should explore the effect of measuring deviation and analysing morphology.
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Multicenter Study
20 Risk factors for admission at three, urban emergency departments in england: a cross-sectional analysis of attendances over one month.
To investigate factors associated with unscheduled admission following presentation to Emergency Departments (EDs) at three hospitals in England. ⋯ This study found statistically significant variations in odds of admission between hospital sites when adjusting for various patient demographic and presentation factors, suggesting important variations in ED- and clinician-level behaviour relating to admission decisions. The four-hour target is a strong driver for emergency admission.
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A short-cut review was carried out to establish whether the Manchester Acute Coronary Syndromes (MACS) and Troponin-only MACS (T-MACS) decision aids can safely rule out acute coronary syndromes in patients presenting to the ED with suspected cardiac chest pain. Six studies were directly relevant to the question. ⋯ The clinical bottom line is that both rules have high sensitivity for acute coronary syndromes, including the detection of major adverse cardiac events at 30 days. The original MACS algorithm may have marginally greater sensitivity than T-MACS but has inferior specificity and requires the use of a biomarker assay (for heart-type fatty acid binding protein) that is not currently widely used in practice.
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55 'Mini Sim' - innovative bite sized simulation teaching in a busy children's emergency department.
: Emergency Medicine requires a highly skilled workforce who are passionate about delivering excellent patient care. Shift patterns linked with the ever increasing numbers of patients who attend Emergency Departments puts strain on educating the workforce and fostering team togetherness. Our objective in devising and instigating the 'Mini Sim' programme was to embed regular in-situ simulation training to enhance the learning of all staff within our Emergency Department team, building a highly trained workforce to deliver excellent care within the remit of our busy department. ⋯ After the simulation a debrief is held and any additional teaching is carried out to embed learning. Each medical participant is then offered the opportunity to complete a work place based assessment on the 'Mini Sim' for their e-portfolio.emermed;34/12/A899-a/F1F1F1Figure 1Evaluation of impact of 'mini sim'The work flow of the department has been unaffected and we have received excellent written feedback from participants about the educational quality of the programme which has also shown improvements in staff confidence in dealing with a variety of emergency situations. We would suggest this model could be used in other departments for similar gain.emermed;34/12/A899-a/F2F2F2Figure 2.