Emergency medicine journal : EMJ
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The number of ventricular assist devices (VADs) being implanted for terminal heart failure is rising at an exponential rate. These implanted patients have a decreased mortality, but still have significant morbidities, as the prevalence of these patients increases in the community. When VAD patients are discharged to home, they will very likely require emergency medical services (EMSs) and emergency medical doctors (EDs) with their future care. ⋯ The cardiovascular treatment of VAD patients in the field can pose different challenges typically encountered including difficulties measuring a pulse and sometimes undetectable BP. Despite these unique challenges, official guidelines or even standard operating procedures regarding the emergency treatment of VAD patients are still lacking. We present a basic overview of the most commonly used left VAD systems and propose guidelines that should be followed in the event of an emergency with a VAD patient out of hospital.
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: The Paediatric Emergency Unit at the University Hospital of Wales provides care for over 33 000 children per year. There was no provision in place to support suddenly bereaved families. Staff felt that we could improve the services provided to families who's children sadly died in the unit. ⋯ Due to the success of this pathway it has been extended to include young adults up to the age of 25 years. The model has also been rolled out across critical care in UHW and is now being used in all emergency department in Wales. This innovative partnership offers immediate support to bereaved families across Wales which has improved care and services provided by the University Health Board.
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: Patient Experience of the Trauma System (PETS)Trauma care is highly organised, time critical medicine. Changes to patient management in trauma care are often the result of Random Control Trials, and expert opinion following rigorous evaluation of the evidence. ⋯ As evidence already suggests that patients with high stress levels have poorer outcomes, we wanted to investigate the patient perception of the trauma system. We were particularly interested to find out if there were any areas where patient anxieties could be reduced or eliminated.
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"Black Swans", originally described as an economic theory, are unexpected events whose potential to occur only becomes apparent after they have happened. The concept is very relevant to the practice of Emergency Medicine and this article explores how black swans impact on emergency care and how staff unconsciously aim to mitigate against them.