Emergency medicine journal : EMJ
-
Early assessment of patients with suspected transient ischaemic attack (TIA) is crucial to provision of effective care, including initiation of preventive therapies and identification of stroke mimics. Many patients with TIA present to emergency medical services (EMS) but may not require hospitalisation. Paramedics could identify and refer patients with low-risk TIA, without conveyance to the ED. Safety and effectiveness of this model is unknown. ⋯ The TIER feasibility study did not meet its progression criteria, largely due to low patient identification and referral rates. A fully powered RCT in this setting is not recommended.
-
The passage of kidney stones through the ureter creates renal colic, a severe visceral abdominal pain. Renal colic is typically managed with non-steroidal anti-inflammatory drugs and opioids. Yet, these treatments often fail to provide adequate pain relief. The erector spinae plane block (ESPB) has emerged as a potential alternative treatment. This systematic review summarises the current body of evidence on the efficacy and safety of ESPB for renal colic in the ED. ⋯ CRD42024554077.
-
Attempting to improve emergency care (EC) advanced clinical practitioner (ACP) training, Health Education England (HEE) South West (SW) implemented a pilot, whereby emergency departments (ED) were provided with enhanced funding and support to help ED consultants deliver teaching and supervision to EC ACPs to ensure more timely completion of EC ACP training compared with previous cohorts training in the region.We explored the experiences of trainee EC ACPs and consultant EC ACP leads working in EDs, which had implemented the new regional pilot. ⋯ A clear supervision structure with protected time allocated for teaching and assessment of clinical skills within the ED is essential to facilitate trainee EC ACP progression. However, increasing demands on EDs make this a challenging goal to achieve. Role identity issues continue to persist despite the introduction of new guidance designed to provide more clarity around the ACP role.
-
Because of their young age and lack of known comorbidities, paediatric patients with out-of-hospital cardiac arrest (OHCA) often undergo prolonged cardiopulmonary resuscitation (CPR). We aimed to determine the association between prehospital and in-hospital CPR duration and neurological outcomes. ⋯ Using a large Japanese database of paediatric OHCA patients, we found that longer CPR duration was associated with a lower likelihood of a 1-month moderate disability or better neurological outcome. Less than 1% of paediatric patients exhibited 1-month moderate disability or better neurological outcomes when total CPR duration is more than 64 min.