Emergency medicine journal : EMJ
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Randomized Controlled Trial Multicenter Study
Structure, process and outcomes of chest pain units established in the ESCAPE trial.
Chest pain units (CPUs) provide a system of care for patients with acute chest pain that can improve outcomes while reducing health service costs. The Effectiveness and Safety of Chest Pain Assessment to Prevent Emergency Admissions (ESCAPE) multicentre trial was undertaken to determine whether CPUs could be successfully established throughout the National Health Service (NHS). ⋯ CPU care can be instituted in a safe manner at a variety of NHS hospitals, with most patients being discharged after assessment. However, there is variation in the number and type of patients managed by the different units. Further research is required to identify reasons for variation in CPU activity.
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Multicenter Study
Cardiac monitoring of high-risk patients after an electrical injury: a prospective multicentre study.
To report our experience monitoring patients with previously identified theoretical risk factors of significant electrical injury. ⋯ Although only patients deemed at risk of late arrhythmias were monitored, none developed potentially lethal late arrhythmias. Asymptomatic patients with transthoracic current and/or tetany and a normal initial ECG do not require cardiac monitoring after an electrical injury with voltage <1000 V and no loss of consciousness.
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Multicenter Study Comparative Study
Safe access/egress systems for emergency ambulances.
To comparatively evaluate the three most widely used ambulance stretcher loading systems; easi-loader, ramp/winch and tail lift to identify a preferred system based on safety and usability evidence. ⋯ The tail lift was found to be the preferred and safest loading system from both the field and laboratory research and is the recommended option from the evaluated loading systems.
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Multicenter Study
Bupivacaine in the emergency department is underused: scope for improved patient care.
To determine patterns of local anaesthetic use, knowledge and perceived use of local anaesthetic by emergency department doctors, and barriers to bupivacaine use. ⋯ Bupivacaine seems to be underused in some appropriate circumstances. Accordingly, there is scope for improvement in patient care through critical evaluation of local anaesthetic practice. This is particularly necessary because barriers to bupivacaine use are often non-clinical (habit, availability, familiarity) rather than clinical (toxicity, onset time).
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Multicenter Study
Use of non-invasive ventilation in UK emergency departments.
To describe the current use of non-invasive ventilation in UK emergency departments. ⋯ NIV is commonly used in UK emergency departments. Practices vary significantly. One solution would be the development of guidelines on when and how to use NIV in emergency medicine practice.