Articles: emergency-medicine.
-
Randomized Controlled Trial Clinical Trial
Optimization of glottic exposure during intubation of a patient lying supine on the ground.
Two methods of endotracheal intubation of patients lying on the ground were compared for ease and speed of intubation and minimization of complications in a crossover study of prehospital-oriented emergency physicians. Intubation of a mannequin was attempted by the physicians in either a left lateral decubitus (LLD) position or a kneeling (K) position, followed by the alternate position. ⋯ Intubation times were 10.5 versus 14.6 seconds in the LLD and K positions, respectively (P < .001). The LLD position is a more effective position (in a mannequin model) than the K position for intubation of patients found lying on the ground, a frequent situation in prehospital care.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Paramedic evaluation of clinical indicators of cervical spinal injury.
Standard prehospital practice includes frequent immobilization of blunt trauma patients, oftentimes based solely on mechanism. Unnecessary cervical spine (c-spine) immobilization does have disadvantages, including morbidity such as low back pain and splinting, increased scene time and costs, and patient-paramedic conflict. Some emergency physicians (EPs) use clinical criteria to clear trauma patients of c-spine injury. If paramedics were able to apply clinical criteria in the out-of-hospital setting, then unnecessary c-spine immobilization could be safely avoided. The authors designed a prospective, randomized, simulated trial to determine the level of agreement between paramedic and EP assessments of clinical indicators of c-spine injury, hypothesizing that there would be substantial agreement between them. ⋯ In this model, there was excellent agreement between paramedics and physicians when evaluating simulated patients for possible c-spine injury. No patient requiring immobilization would have been clinically cleared by paramedics. These data support the progression to a prospective field trial evaluating the use of these criteria by paramedics.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Randomised controlled trial of general practitioner versus usual medical care in an urban accident and emergency department: process, outcome, and comparative cost.
To see whether care provided by general practitioners to non-emergency patients in an accident and emergency department differs significantly from care by usual accident and emergency staff in terms of process, outcome, and comparative cost. ⋯ General practitioners working as an integral part of an accident and emergency department manage non-emergency accident and emergency attenders safely and use fewer resources than do usual accident and emergency staff.
-
Randomized Controlled Trial Clinical Trial
The oesophageal detector device. An assessment of accuracy and ease of use by paramedics.
Accuracy, ease and speed of recognition of tracheal tube position were assessed using the oesophageal detector device in a series of 40 tests on 29 patients. A single blind method was used, with each paramedic performing a single test on each patient. The tests were randomly split between two groups consisting of those tests performed on the tracheal or oesophageal tube respectively. ⋯ Each paramedic also graded speed of recognition of position and ease of use of the device. Recognition of position was graded as instant in 37 out of 40 tests. Use of the oesophageal detector device by previously inexperienced paramedics has thus been shown to be accurate, rapid and easy to learn.
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
[Initial defibrillation by emergency physicians or by first aid assistants? A prospective, comparative multicenter study in outpatients with ventricular fibrillation].
In a controlled prospective randomized study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany (basic life support by EMTs and defibrillation by emergency physicians only) in order to answer the following questions: 1. Does EMT defibrillation improve the survival rate and long-term prognosis of patients in ventricular fibrillation as compared to the current German standards in resuscitation (basic life support by EMTs and defibrillation by emergency physicians)? 2. Are the prerequisites for the use of semiautomatic defibrillators fulfilled in the emergency medical systems (EMS) of the participating centers? METHODS. ⋯ Neither the initial survival rate the number of patients discharged alive, nor the neurological long-term prognosis was significantly different for any of the groups investigated. Because of apparent differences in indirect prognostic parameters (time interval until ROSC, number of patients requiring no epinephrine) and because of the fact that the time interval to the first defibrillation was reduced by EMT defibrillation, EMT-Ds may perform defibrillation if: (a) they reach the patient before the emergency physician and (b) if they are trained intensively and supervised continuously. In order to increase the efficiency of defibrillation by EMT-Ds, far-reaching changes in our EMS are mandatory: (a) a reduction in the time interval from collapse until initiation of BCLS measures by intensifying layperson CPR training; (b) an increase in the number of emergency units equipped with semiautomatic defibril