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East Midlands EM Journal Club Beta

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9 papers 0 to 25 followers East Midlands EM Journal Club
By Graham Johnson Emergency and Paediatric Emergency Physician
G Sarah Power, David A Harrison, Paul R Mouncey, Tiffany M Osborn, Sheila E Harvey, Kathryn M Rowan
BACKGROUND: The Protocolised Management in Sepsis (ProMISe) trial is an open, multicentre, randomised controlled trial (RCT) of the clinical effectiveness and cost-effectiveness of early, goal directed, protocolised resuscitation compared with usual resuscitation for patients presenting to emergency departments (EDs) in the United Kingdom with early signs of severe sepsis or septic shock. The rationale for the ProMISe trial derives from a single-centre United States RCT that reported a reduction in hospital mortality from 46...
December 2013: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
D C Angus, A E Barnato, D Bell, R Bellomo, C-R Chong, T J Coats, A Davies, A Delaney, D A Harrison, A Holdgate, B Howe, D T Huang, T Iwashyna, J A Kellum, S L Peake, F Pike, M C Reade, K M Rowan, M Singer, S A R Webb, L A Weissfeld, D M Yealy, J D Young
PURPOSE: To determine whether early goal-directed therapy (EGDT) reduces mortality compared with other resuscitation strategies for patients presenting to the emergency department (ED) with septic shock. METHODS: Using a search strategy of PubMed, EmBase and CENTRAL, we selected all relevant randomised clinical trials published from January 2000 to January 2015. We translated non-English papers and contacted authors as necessary. Our primary analysis generated a pooled odds ratio (OR) from a fixed-effect model...
September 2015: Intensive Care Medicine
E Rivers, B Nguyen, S Havstad, J Ressler, A Muzzin, B Knoblich, E Peterson, M Tomlanovich
BACKGROUND: Goal-directed therapy has been used for severe sepsis and septic shock in the intensive care unit. This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen delivery with oxygen demand. The purpose of this study was to evaluate the efficacy of early goal-directed therapy before admission to the intensive care unit. METHODS: We randomly assigned patients who arrived at an urban emergency department with severe sepsis or septic shock to receive either six hours of early goal-directed therapy or standard therapy (as a control) before admission to the intensive care unit...
November 8, 2001: New England Journal of Medicine
Terje Sundstrøm, Helge Asbjørnsen, Samer Habiba, Geir Arne Sunde, Knut Wester
The cervical collar has been routinely used for trauma patients for more than 30 years and is a hallmark of state-of-the-art prehospital trauma care. However, the existing evidence for this practice is limited: Randomized, controlled trials are largely missing, and there are uncertain effects on mortality, neurological injury, and spinal stability. Even more concerning, there is a growing body of evidence and opinion against the use of collars. It has been argued that collars cause more harm than good, and that we should simply stop using them...
March 15, 2014: Journal of Neurotrauma
Jeffrey J Perry, Ian G Stiell, Marco L A Sivilotti, Michael J Bullard, Marcel Emond, Cheryl Symington, Jane Sutherland, Andrew Worster, Corinne Hohl, Jacques S Lee, Mary A Eisenhauer, Melodie Mortensen, Duncan Mackey, Merril Pauls, Howard Lesiuk, George A Wells
OBJECTIVE: To measure the sensitivity of modern third generation computed tomography in emergency patients being evaluated for possible subarachnoid haemorrhage, especially when carried out within six hours of headache onset. DESIGN: Prospective cohort study. SETTING: 11 tertiary care emergency departments across Canada, 2000-9. PARTICIPANTS: Neurologically intact adults with a new acute headache peaking in intensity within one hour of onset in whom a computed tomography was ordered by the treating physician to rule out subarachnoid haemorrhage...
July 18, 2011: BMJ: British Medical Journal
Niklas Nielsen, Jørn Wetterslev, Tobias Cronberg, David Erlinge, Yvan Gasche, Christian Hassager, Janneke Horn, Jan Hovdenes, Jesper Kjaergaard, Michael Kuiper, Tommaso Pellis, Pascal Stammet, Michael Wanscher, Matt P Wise, Anders Åneman, Nawaf Al-Subaie, Søren Boesgaard, John Bro-Jeppesen, Iole Brunetti, Jan Frederik Bugge, Christopher D Hingston, Nicole P Juffermans, Matty Koopmans, Lars Køber, Jørund Langørgen, Gisela Lilja, Jacob Eifer Møller, Malin Rundgren, Christian Rylander, Ondrej Smid, Christophe Werer, Per Winkel, Hans Friberg
BACKGROUND: Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever. METHODS: In an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33°C or 36°C...
December 5, 2013: New England Journal of Medicine
Ian Roberts, Haleema Shakur, Adefemi Afolabi, Karim Brohi, Tim Coats, Yashbir Dewan, Satoshi Gando, Gordon Guyatt, B J Hunt, Carlos Morales, Pablo Perel, David Prieto-Merino, Tom Woolley
BACKGROUND: The aim of the CRASH-2 trial was to assess the effects of early administration of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage. Tranexamic acid significantly reduced all-cause mortality. Because tranexamic acid is thought to exert its effect through inhibition of fibrinolysis, we undertook exploratory analyses of its effect on death due to bleeding. METHODS: The CRASH-2 trial was undertaken in 274 hospitals in 40 countries...
March 26, 2011: Lancet
Deborah J Novak, Yu Bai, Rhonda K Cooke, Marisa B Marques, Magali J Fontaine, Jerome L Gottschall, Patricia M Carey, Richard M Scanlan, Eberhard W Fiebig, Ira A Shulman, Janice M Nelson, Sherri Flax, Veda Duncan, Jennifer A Daniel-Johnson, Jeannie L Callum, John B Holcomb, Erin E Fox, Sarah Baraniuk, Barbara C Tilley, Martin A Schreiber, Kenji Inaba, Sandro Rizoli, Jeanette M Podbielski, Bryan A Cotton, John R Hess
BACKGROUND: The Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial was a randomized clinical trial comparing survival after transfusion of two different blood component ratios for emergency resuscitation of traumatic massive hemorrhage. Transfusion services supporting the study were expected to provide thawed plasma, platelets, and red blood cells within 10 minutes of request. STUDY DESIGN AND METHODS: At the 12 Level 1 trauma centers participating in PROPPR, blood components transfused and delivery times were tabulated, with a focus on universal donor (UD) plasma management...
June 2015: Transfusion
Peter J Gill, Michael J Goldacre, David Mant, Carl Heneghan, Anne Thomson, Valerie Seagroatt, Anthony Harnden
OBJECTIVE: To investigate a reported rise in the emergency hospital admission of children in England for conditions usually managed in the community. SETTING AND DESIGN: Population-based study of hospital admission rates for children aged under 15, based on analysis of Hospital Episode Statistics and population estimates for England, 1999-2010. MAIN OUTCOME: Trends in rates of emergency admission to hospital. RESULTS: The emergency admission rate for children aged under 15 in England has increased by 28% in the past decade, from 63 per 1000 population in 1999 to 81 per 1000 in 2010...
May 2013: Archives of Disease in Childhood
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