Emergency medicine journal : EMJ
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Observational Study
Location of arrest and effect of prehospital advanced airway management after emergency medical service-witnessed out-of-hospital cardiac arrest: nationwide observational study.
What is this?
This Korean study investigated 6,620 out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical providers, covering a four year period of the Korean OHCA registry. They looked at outcome among those receiving advanced airway intervention, comparing arrest at scene to arrest in the ambulance.
Why is this interesting?
Past studies have suggested better OHCA outcomes when a supraglottic airway (SGA) is used rather than endotrachial intubation (ETI). We also know that repeated advanced airway attempts are detrimental, and that airway intervention can interrupt CPR.
What was not known is:
- Whether SGA placement is detrimental or beneficial, compared with basic airway support, and;
- Whether there is any difference if the arrest occurs at the scene or in the confines of an ambulance.
And they found:
There was no benefit from advanced airway intervention (SGA or ETI) for EMS witnessed out-of-hospital arrest – and in fact there was an associated worse neurological outcome for in-ambulance OHCA when the airway was instrumented compared to any other group.
Don’t be hasty...
Although the authors reasonably describe the ways in which providing advanced airway interventions in the confines of an ambulance may impede other resuscitation, thus worsening outcomes, it may also be that a patient who still arrests despite receiving EMS care in the back of an ambulance is by definition at risk of worse outcomes despite medical care.
Nevertheless, at worst this retrospective observational study suggests there is no benefit of advanced airways in OHCA.
Bonus...
The authors also provide an interesting overview of the Korean emergency medical system, servicing 50 million people in urban and rural areas. This is an enlightening insight into how one country has structured its EMS service.
summary -
Dental emergencies are common reasons for presenting to hospital emergency departments. Here, we discuss the panoramic radiograph (orthopantomogram (OPG, OPT) as a diagnostic tool for the assessment of mandibular trauma and odontogenic infections. ⋯ The aim is to equip the emergency physician with the skills to use the OPG radiograph when available, and to rapidly assess the image to expedite patient management. Included is a discussion of a number of cases seen in the emergency setting and some common errors in diagnosis.
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Comparative Study
Exploring the characteristics, acuity and management of adult ED patients at night-time.
ED care is required for acutely unwell and injured patients 24 hours a day, 7 days a week. The aim of this study was to compare characteristics and activity of type 1 ED attendances according to whether their time of arrival was during the day (08:00-18:00) or at night (18:00-08:00). ⋯ There is an 'overnight effect' of patients attending EDs. Patients wait longer, leave without being seen, attend with non-urgent problems and are more likely to be admitted for a short stay. Further work is required to identify the potential underlying causes of these differences.