Emergency medicine journal : EMJ
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The management of hypothermic casualties is a challenge faced by all prehospital and search and rescue (SAR) teams. It is not known how the practice of these diverse teams compare. The aim of this study was to review prehospital hypothermia management across a wide range of SAR providers in the UK. ⋯ This survey describes current practice in prehospital hypothermia management, comparing the various methods used by different teams, and provides a basis to direct further education and research.
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A short-cut review was carried out to establish whether a normal gait examination can rule out cerebellar stroke in patients with acute vertigo. 16 studies were relevant to the question. The author, year and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that a normal gait examination cannot rule out a cerebellar stroke but the presence of an abnormal gait can be associated.
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Rapid Analgesia for Prehospital Hip Disruption was a small study designed to determine the feasibility of undertaking a randomised controlled trial (RCT) to test the clinical and cost-effectiveness of paramedics administering Fascia Iliaca Compartment Block as early prehospital pain relief to patients with a fractured hip. The objective was to devise a simple and effective method of random allocation concealment suitable for use by paramedics while in the emergency prehospital setting. ⋯ Paramedics can use scratchcards as a method of randomly allocating patients in trials in prehospital care. In the future, a method that allows only the top card to be selected and a more protective method of storing the cards should be used. Scratchcards can be considered for wider use in RCTs in the emergency prehospital setting.
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The majority of paediatric ED visits result in discharge but little is known about what ED resources are deployed for these visits. The goal of this study was to understand the utilisation of diagnostic testing, procedures and hospital admission for paediatric ED visits triaged as 'non-urgent'. ⋯ A significant percentage of ED patients with non-urgent ED triage scores received ED testing and procedures. More work is needed to improve methods of prospectively identifying patients with low acuity complaints who do not need significant ED resources.
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Observational Study
The presence of companions during emergency department evaluation and its impact on perceptions of clinician-patient communication.
Research in outpatient setting suggests that the presence of companions during a medical encounter can improve clinician-patient communication. It is not known if the presence of companions has a similar effect in the acutely stressful context of the ED. This study tested whether the presence of companions in the ED relate to stronger clinician-patient communication. We further explored effect modification by demographic factors (race/ethnicity, education and language) thought to compromise communication. ⋯ Neither the presence of companions nor demographic factors were related to clinician-patient communication. The interaction effect suggesting that patients completing high school or less have the most to gain from the presence of close others warrants further exploration.