Muhammet Sukru Paksu, Mehtap Kilic
No abstract text is available yet for this article.
September 28, 2020: Emergency Medicine Journal: EMJ
Henry Walton, Annakan Victor Navaratnam, Martyn Ormond, Vanita Gandhi, Clifford Mann
BACKGROUND: The COVID-19 pandemic has stretched EDs globally, with many regions in England challenged by the number of COVID-19 presentations. In order to rapidly share learning to inform future practice, we undertook a thematic review of ED operational experience within England during the pandemic thus far. METHODS: A rapid phenomenological approach using semistructured telephone interviews with ED clinical leads from across England was undertaken between 16 and 22 April 2020...
September 28, 2020: Emergency Medicine Journal: EMJ
Rosa McNamara, Kerri Donnelly, Nichola Boyle, David Menzies, Rebecca Hollywood, Elizabeth Little, Eoin Tiernan, Karen Donohoe, Aidan Delaney, Fionnuala Duffy, Eoin Feeney, Shane O'Hanlon
We describe the expansion and adaptation of a frailty response team to assess older people in their usual place of residence. The team had commenced a weekend service to a limited area in February 2020. As a consequence of demand related to the COVID-19 pandemic, we expanded it and adapted the model of care to provide a 7-day service to our entire catchment area. Five hundred and ninety two patient reviews have been completed in the first 105 days of operation with 43 patients transferred to hospital for further investigation or management following assessment...
September 24, 2020: Emergency Medicine Journal: EMJ
David L Murphy, Leslie M Barnard, Christopher J Drucker, Betty Y Yang, Jamie M Emert, Leilani Schwarcz, Catherine R Counts, Tracie Y Jacinto, Andrew M McCoy, Tyler A Morgan, Jim E Whitney, Joel V Bodenman, Jeffrey S Duchin, Michael R Sayre, Thomas D Rea
Rigorous assessment of occupational COVID-19 risk and personal protective equipment (PPE) use is not well-described. We evaluated 9-1-1 emergency medical services (EMS) encounters for patients with COVID-19 to assess occupational exposure, programmatic strategies to reduce exposure and PPE use. We conducted a retrospective cohort investigation of laboratory-confirmed patients with COVID-19 in King County, Washington, USA, who received 9-1-1 EMS responses from 14 February 2020 to 26 March 2020. We reviewed dispatch, EMS and public health surveillance records to evaluate the temporal relationship between exposure and programmatic changes to EMS operations designed to identify high-risk patients, protect the workforce and conserve PPE...
September 21, 2020: Emergency Medicine Journal: EMJ
Marcela P Vizcaychipi, Claire L Shovlin, Alex McCarthy, Alice Howard, Alexander Brown, Michelle Hayes, Suveer Singh, Linsey Christie, Alice Sisson, Roger Davies, Christopher Lockie, Monica Popescu, Amandeep Gupta, James Armstrong, Hisham Said, Timothy Peters, Richard T Keays
Common causes of death in COVID-19 due to SARS-CoV-2 include thromboembolic disease, cytokine storm and adult respiratory distress syndrome (ARDS). Our aim was to develop a system for early detection of disease pattern in the emergency department (ED) that would enhance opportunities for personalised accelerated care to prevent disease progression. A single Trust's COVID-19 response control command was established, and a reporting team with bioinformaticians was deployed to develop a real-time traffic light system to support clinical and operational teams...
September 18, 2020: Emergency Medicine Journal: EMJ
Katie Walker, Kathryn Yu, Zhi Shyuan Seraphina Choong, Anne Loupis, Gary Richardson
No abstract text is available yet for this article.
September 18, 2020: Emergency Medicine Journal: EMJ
Helen E Hughes, Thomas C Hughes, Roger Morbey, Kirsty Challen, Isabel Oliver, Gillian E Smith, Alex J Elliot
On 12 March 2020 the UK entered the 'delay phase' of the COVID-19 pandemic response. The Public Health England Emergency Department Syndromic Surveillance System (EDSSS) carries out daily (near real-time) public health surveillance of emergency department (ED) attendances across England. This retrospective observational analysis of EDSSS data aimed to describe changes in ED attendances during March-April 2020, and identify the attendance types with the largest impact. Type 1 ED attendances were selected from 109 EDs that reported data to EDSSS for the period 1 January 2019 to 26 April 2020...
September 18, 2020: Emergency Medicine Journal: EMJ
Ewoud Ter Avest, Sam Taylor, Mark Wilson, Richard L Lyon
BACKGROUND: For the prehospital diagnosis of raised intracranial pressure (ICP), clinicians are reliant on clinical signs such as the Glasgow Coma Score (GCS), pupillary response and/or Cushing's triad (hypertension, bradycardia and an irregular breathing pattern). This study aimed to explore the diagnostic accuracy of these signs as indicators of a raised ICP. METHODS: We performed a retrospective cohort study of adult patients attended by a Helicopter Emergency Medical Service (Air Ambulance Kent, Surrey Sussex), who had sustained a traumatic brain injury (TBI), requiring prehospital anaesthesia between 1 January 2016 and 1 January 2018...
September 18, 2020: Emergency Medicine Journal: EMJ
Giles N Cattermole, Appolinaire Manirafasha
INTRODUCTION: Weight estimation of both adult and paediatric patients is often necessary in emergency or low-resource settings when it is not possible to weigh the patient. There are many methods for paediatric weight estimation, but no standard methods for adults. PAWPER and Mercy tapes are used in children, but have not been assessed in adults. The primary aim of this study was to assess weight estimation methods in patients of all ages. METHODS: Patients were prospectively recruited from emergency and outpatient departments in Kigali, Rwanda...
September 17, 2020: Emergency Medicine Journal: EMJ
Steven Paling, Jennifer Lambert, Jasper Clouting, Júlia González-Esquerré, Toby Auterson
BACKGROUND: Long lengths of stay (also called waiting times) in emergency departments (EDs) are associated with higher patient mortality and worse outcomes. OBJECTIVE: To add to the literature using high-frequency data from a large number of hospitals to analyse factors associated with long waiting times, including exploring non-linearities for 'tipping points'. METHODS: Multivariate ordinary least squares regressions with fixed effects were used to analyse factors associated with the proportion of patients in EDs in England waiting more than 4 hours to be seen, treated and admitted or discharged...
September 15, 2020: Emergency Medicine Journal: EMJ
James Price, Daniel D Sandbach, Ari Ercole, Alastair Wilson, Ed Benjamin Graham Barnard
OBJECTIVES: In the UK, 20% of patients with severe traumatic brain injury (TBI) receive prehospital emergency anaesthesia (PHEA). Current guidance recommends an end-tidal carbon dioxide (ETCO2 ) of 4.0-4.5 kPa (30.0-33.8 mm Hg) to achieve a low-normal arterial partial pressure of CO2 (PaCO2 ), and reduce secondary brain injury. This recommendation assumes a 0.5 kPa (3.8 mm Hg) ETCO2 -PaCO2 gradient. However, the gradient in the acute phase of TBI is unknown. The primary aim was to report the ETCO2 -PaCO2 gradient of TBI patients at hospital arrival...
September 14, 2020: Emergency Medicine Journal: EMJ
Danielle M Coombs, Gustavo C Machado, Bethan Richards, Crystian B Oliveira, Robert D Herbert, Chris G Maher
INTRODUCTION: Low back pain, and especially non-specific low back pain, is a common cause of presentation to the emergency department (ED). Although these patients typically report relatively high pain intensity, the clinical course of their pain and disability remains unclear. Our objective was to review the literature and describe the clinical course of non-specific low back pain after an ED visit. METHODS: Electronic searches were conducted using MEDLINE, CINAHL and EMBASE from inception to March 2019...
September 11, 2020: Emergency Medicine Journal: EMJ
Edward Hyun Suh, David J Bodnar, Laura D Melville, Manish Sharma, Brenna M Farmer
The pandemic of COVID-19 has been particularly severe in the New York City area, which has had one of the highest concentrations of cases in the USA. In March 2020, the EDs of New York-Presbyterian Hospital, a 10-hospital health system in the region, began to experience a rapid surge in patients with COVID-19 symptoms. Emergency physicians were faced with a disease that they knew little about that quickly overwhelmed resources. A significant amount of attention has been placed on the problem of limited supply of ventilators and intensive care beds for critically ill patients in the setting of the ongoing global pandemic...
September 10, 2020: Emergency Medicine Journal: EMJ
Ruud Gerard Nijman, Johanna Krone, Santiago Mintegi, Christoph Bidlingmaier, Ian K Maconochie, Mark D Lyttle, Ulrich von Both
BACKGROUND: Refugee children and young people have complex healthcare needs. However, issues related to acute healthcare provision for refugee children across Europe remain unexplored. This study aimed to describe the urgent and emergency healthcare needs of refugee children in Europe, and to identify obstacles to providing this care. METHODS: An online cross-sectional survey was distributed to European healthcare professionals via research networks between 1 February and 1 October 2017 addressing health issues of children and young people aged <18 years fulfilling international criteria of refugee status, presenting to emergency departments...
September 9, 2020: Emergency Medicine Journal: EMJ
Cian McDermott, Joseph Daly, Simon Carley
The current COVID-19 pandemic is causing diagnostic and risk stratification difficulties in Emergency Departments (ED) worldwide. Molecular tests are not sufficiently sensitive, and results are usually not available in time for decision making in the ED. Chest x-ray (CXR) is a poor diagnostic test for COVID-19, and computed tomography (CT), while sensitive, is impractical as a diagnostic test for all patients. Lung ultrasound (LUS) has an established role in the evaluation of acute respiratory failure and has been used during the COVID-19 outbreak as a decision support tool...
September 9, 2020: Emergency Medicine Journal: EMJ
Gordon Fuller, Lisa Sabir, Rachel Evans, Daniel Bradbury, Maxine Kuczawski, Suzanne M Mason
BACKGROUND: Patients taking direct oral anticoagulants (DOACs) commonly undergo CT head imaging after minor head injury, regardless of symptoms or signs. However, the risk of intracranial haemorrhage (ICH) in such patients is unclear, and further research has been recommended by the UK National Institute for Health and Care Excellence head injury guideline group. METHODS: An observational cohort study was performed in the UK South Yorkshire major trauma centre between 26 June and 3 September 2018...
September 8, 2020: Emergency Medicine Journal: EMJ
Ahmad A Aalam, Awad Alsabban, Jesse M Pines
BACKGROUND: Chest pain is a common complaint in EDs. In this study, we describe demographic, care and cost trends in US ED visits for chest pain over 11 years. METHODS: This is a retrospective descriptive study of trends in utilisation and care of ED chest pain visits from 2006 to 2016) using data from the Healthcare Cost and Utilization Project database, a national sample of US ED visits and hospitalisations. RESULTS: From 2006 to 2016, there were 42...
September 8, 2020: Emergency Medicine Journal: EMJ
Peter J Snelling, Philip Jones, Gerben Keijzers, David Bade, David W Herd, Robert S Ware
BACKGROUND: Paediatric distal forearm fractures are a common ED presentation. They can be diagnosed with point-of-care ultrasound (POCUS) as an alternative to X-rays. Given that ED nurse practitioners (NPs) are relied on for the diagnosis of paediatric fractures, it is important to describe the diagnostic accuracy of NP-conducted POCUS versus X-ray. METHODS: This prospective diagnostic study was conducted in a tertiary paediatric hospital in Queensland, Australia, between February 2018 and April 2019...
September 8, 2020: Emergency Medicine Journal: EMJ
Nicholas Tilbury, Graham D Johnson, Zoe Rusk, Carol Byrne, Maleasha Shergill, Adam Churchman, Andrew Tabner
BACKGROUND: Staff use of smartphones and tablets in the healthcare setting is increasingly prevalent, but little is known about whether this use is acceptable to patients. Staff are concerned that the use of handheld electronic devices (HEDs) may be negatively misconstrued by patients. The HED can be a valuable tool, offering the emergency clinician access to a wealth of resources; it is therefore vital that patient views are addressed during their widespread adoption into clinical practice...
September 8, 2020: Emergency Medicine Journal: EMJ
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No abstract text is available yet for this article.
September 7, 2020: Emergency Medicine Journal: EMJ
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