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1.
Emerg Med Clin North Am ; 38(1): 1-13, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757244

RESUMO

Acute musculoskeletal injuries are commonly seen in our emergency departments, and are commonly missed. There are many reasons for more missed injures and a significant one is over-reliance on radiographs. An emergency department orthopedic assessment goes far beyond the radiographs. A focused, yet comprehensive history is vital to understand the forces and mechanism of injury. That injury must be understood in the context of the patient, because older and much younger patients have weaker bone. Finally, the physical examination is instrumental in localizing the pathology and is essential to put radiograph results in the proper clinical context.


Assuntos
Gerenciamento Clínico , Medicina de Emergência/métodos , Procedimentos Ortopédicos/métodos , Exame Físico/métodos , Radiografia/métodos , Ferimentos e Lesões/terapia , Humanos , Ferimentos e Lesões/diagnóstico
2.
Wilderness Environ Med ; 30(4): 425-430, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31694782

RESUMO

Massive hemorrhage is an immediate threat to life. The military developed the Tactical Combat Casualty Care guidelines to address the management of acute trauma, including administration of blood products. The guidelines have been expanded to include low titer O whole blood, which is in limited use by the military. This proposal describes how the transfusion of fresh whole blood might be applied to the remote civilian environment. In doing so, this life-saving intervention may be brought to the austere medical environment, allowing critically hemorrhaging patients to survive to reach definitive medical care.


Assuntos
Sistema do Grupo Sanguíneo ABO , Transfusão de Sangue , Hemorragia/terapia , Ferimentos e Lesões/patologia , Doadores de Sangue , Tipagem e Reações Cruzadas Sanguíneas , Preservação de Sangue , Medicina de Emergência/métodos , Acesso aos Serviços de Saúde , Hemorragia/etiologia , Humanos , Ressuscitação , Reação Transfusional , Medicina Selvagem
3.
Curr Med Sci ; 39(5): 690-693, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612384

RESUMO

The occurrence of major emergencies often leads to environmental damage, property damage, health challenges and life threats. Despite the tremendous progress we have made in responding to the many challenges posed by disasters in recent years, there are still many shortcomings. As an emerging technology widely used in recent years, virtual reality (VR) technology is very suitable for many fields of disaster medicine, such as basic education, professional training, psychotherapy, etc. The purpose of this review article is to introduce the application of VR technology in the disaster medical field and prospect its trend in the future.


Assuntos
Medicina de Desastres/métodos , Medicina de Emergência/métodos , Conhecimentos, Atitudes e Prática em Saúde , Realidade Virtual , Medicina de Desastres/educação , Desastres , Medicina de Emergência/educação , Primeiros Socorros/métodos , Humanos , Educação de Pacientes como Assunto/organização & administração
5.
Transplant Proc ; 51(7): 2171-2175, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31327476

RESUMO

PURPOSE: Emergency departments (EDs) are a new focus of interest in recent years as a possible solution for increasing organ donations, as, EDs are full of missed opportunities. In this study, we aimed to determine the barriers to the identification and referral by emergency medicine physicians (EMPs) of potential brain death (BD) cases. MATERIALS AND METHODS: The participants of the study consist of 252 EMPs who had answered the questionnaire sent via e-mail. FINDINGS: The following causes were found in the questionnaire: (1) negative attitudes and lack of knowledge about organ donation in society (63.1%); (2) religious beliefs (57.5%); (3) family refusal (57.1%); (4) disruption of bodily integrity (45.6%); (5) inadequate knowledge of doctors (50.4%); (6) difficulties in predicting the prognosis of the patient and diagnosing BD in EDs (40.1%); (7) fear of negative reactions from relatives of patients (37.7%); (8) the absence of an organ procurement unit (OPU) (36.5%); (9) lack of ideal candidates (27%); (10) increased workload in EDs (23.8%); and (11) fear of legal problems arising (23.8%). Of the participants, 42.9% stated that there was an OPU in their hospital. Of the participants, 15.8% reported that they have good communication with the OPU. CONCLUSIONS: Negative attitudes and lack of knowledge about organ donation in society, religious beliefs, inadequate knowledge of EMPs, and the absence of an OPU in hospitals are important barriers to organ donor notification from EDs. Increasing social awareness and increasing of the level of knowledge of EMPs and close cooperation between OPU and EDs will significantly contribute to the increase of organ donor notifications from EDs.


Assuntos
Atitude do Pessoal de Saúde , Serviço Hospitalar de Emergência , Conhecimentos, Atitudes e Prática em Saúde , Encaminhamento e Consulta , Obtenção de Tecidos e Órgãos/métodos , Adulto , Morte Encefálica , Comunicação , Medicina de Emergência/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doadores de Tecidos/provisão & distribução
6.
Pediatr Emerg Med Pract ; 16(8): 1-24, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31339255

RESUMO

Adequate analgesia is critical in the management of pediatric patients in the emergency department. Suboptimal treatment of pain can have deleterious effects in the short term, and it can also affect a patient's development and reaction to future painful experiences. Tools exist to quantify a patient's pain level regardless of age or developmental stage. Both pharmacologic and nonpharmacologic methods can be effective in the management of pediatric pain. Emergency clinicians must remain vigilant in the recognition, treatment, and reassessment of pediatric pain, as patients' developmental level may limit their ability to independently express their pain experience without prompting or tools. This issue reviews pain scales that are suitable for pediatric patients and discusses pediatric pain management using nonpharmacologic methods, topical, local, and regional anesthesia as well as systemic agents.


Assuntos
Medicina de Emergência/métodos , Serviço Hospitalar de Emergência , Manejo da Dor/métodos , Enfermagem Pediátrica/organização & administração , Analgesia/métodos , Analgésicos/uso terapêutico , Criança , Hospitais Pediátricos , Humanos , Hipnóticos e Sedativos/uso terapêutico
7.
BMC Emerg Med ; 19(1): 40, 2019 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349797

RESUMO

BACKGROUND: The demand on Emergency Departments and acute medical services is increasing internationally, creating pressure on health systems and negatively influencing the quality of delivered care. Visible consequences of the increased demand on acute services is crowding and queuing. This manifests as delays in the Emergency Departments, adverse clinical outcomes and poor patient experience. OVERVIEW: Despite the similarities in the UK's and Dutch health care systems, such as universal health coverage, there are differences in the number of patients presenting at the Emergency Departments and the burden of crowding between these countries. Given the similarities in funding, this paper explores the similarities and differences in the organisational structure of acute care in the UK and the Netherlands. In the Netherlands, less patients are seen at the ED than in England and the admission rate is higher. GPs and so-called GP-posts serve 24/7 as gatekeepers in acute care, but EDs are heterogeneously organised. In the UK, the acute care system has a number of different access points and the accessibility of GPs seems to be suboptimal. Acute ambulatory care may relieve the pressure from EDs and Acute Medical Units. In both countries the ageing population leads to a changing case mix at the ED with an increased amount of multimorbid patients with polypharmacy, requiring generalistic and multidisciplinary care. CONCLUSION: The acute and emergency care in the Netherlands and the UK face similar challenges. We believe that each system has strengths that the other can learn from. The Netherlands may benefit from an acute ambulatory care system and the UK by optimizing the accessibility of GPs 24/7 and improving signposting for urgent care services. In both countries the changing case mix at the ED needs doctors who are superspecialists instead of subspecialists. Finally, to improve the organisation of health care, doctors need to be visible medical leaders and participate in the organisation of care.


Assuntos
Doença Aguda/terapia , Medicina de Emergência/métodos , Medicina de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Aglomeração , Clínicos Gerais , Humanos , Países Baixos , Médicos , Encaminhamento e Consulta , Reino Unido
8.
Drugs ; 79(13): 1395-1418, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31352603

RESUMO

Naloxone is a well-established essential medicine for the treatment of life-threatening heroin/opioid overdose in emergency medicine. Over two decades, the concept of 'take-home naloxone' has evolved, comprising pre-provision of an emergency supply to laypersons likely to witness an opioid overdose (e.g. peers and family members of people who use opioids as well as non-medical personnel), with the recommendation to administer the naloxone to the overdose victim as interim care while awaiting an ambulance. There is an urgent need for more widespread naloxone access considering the growing problem of opioid overdose deaths, accounting for more than 100,000 deaths worldwide annually. Rises in mortality are particularly sharp in North America, where the ongoing prescription opioid problem is now overlaid with a rapid growth in overdose deaths from heroin and illicit fentanyl. Using opioids alone is dangerous, and the mortality risk is clustered at certain times and contexts, including on prison release and discharge from hospital and residential care. The provision of take-home naloxone has required the introduction of new legislation and new naloxone products. These include pre-filled syringes and auto-injectors and, crucially, new concentrated nasal sprays (four formulations recently approved in different countries) with speed of onset comparable to intramuscular naloxone and relative bioavailability of approximately 40-50%. Choosing the right naloxone dose in the fentanyl era is a matter of ongoing debate, but the safety margin of the approved nasal sprays is superior to improvised nasal kits. New legislation in different countries permits over-the-counter sales or other prescription-free methods of provision. However, access remains uneven with take-home naloxone still not provided in many countries and communities, and with ongoing barriers contributing to implementation inertia. Take-home naloxone is an important component of the response to the global overdose problem, but greater commitment to implementation will be essential, alongside improved affordable products, if a greater impact is to be achieved.


Assuntos
Analgésicos Opioides/efeitos adversos , Overdose de Drogas/tratamento farmacológico , Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Animais , Medicina de Emergência/métodos , Humanos , Saúde Pública/métodos
9.
Emerg Med J ; 36(8): 485-492, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31239315

RESUMO

OBJECTIVES: To determine whether the impact of a thoracic CT scan on community-acquired pneumonia (CAP) diagnosis and patient management varies according to emergency physician's experience (≤10 vs >10 years). METHODS: Early thoracic CT Scan for Community-Acquired Pneumonia at the Emergency Department is an interventional study conducted from November 2011 to January 2013 in four French emergency departments, and included suspected patients with CAP. We analysed changes in emergency physician CAP diagnosis classification levels before and after CT scan; and their agreement with an adjudication committee. We performed univariate analysis to determine the factors associated with modifying the diagnosis classification level to be consistent with the radiologist's CT scan interpretation. RESULTS: 319 suspected patients with CAP and 136 emergency physicians (75% less experienced with ≤10 years, 25% with >10 years of experience) were included. The percentage of patients whose classification was modified to become consistent with CT scan radiologist's interpretation was higher among less-experienced than experienced emergency physicians (54.2% vs 40.2%; p=0.02). In univariate analysis, less emergency physician experience was the only factor associated with changing a classification to be consistent with the CT scan radiologist's interpretation (OR 1.77, 95% CI 1.01 to 3.10, p=0.04). After CT scan, the agreement between emergency physicians and adjudication committee was moderate for less-experienced emergency physicians and slight for experienced emergency physicians (k=0.457 and k=0.196, respectively). After CT scan, less-experienced emergency physicians modified patient management significantly more than experienced emergency physicians (36.1% vs 21.7%, p=0.01). CONCLUSIONS: In clinical practice, less-experienced emergency physicians were more likely to accurately modify their CAP diagnosis and patient management based on thoracic CT scan than more experienced emergency physicians. TRIAL REGISTRATION NUMBER: NCT01574066.


Assuntos
Competência Clínica/normas , Infecções Comunitárias Adquiridas/terapia , Medicina de Emergência/normas , Acontecimentos que Mudam a Vida , Adulto , Competência Clínica/estatística & dados numéricos , Infecções Comunitárias Adquiridas/complicações , Tomada de Decisões , Medicina de Emergência/métodos , Medicina de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumonia/terapia , Estudos Prospectivos , Estatísticas não Paramétricas , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/normas , Tomografia Computadorizada por Raios X/estatística & dados numéricos
10.
Emerg Med Pract ; 21(7): 1-28, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31233303

RESUMO

As bariatric procedures have become more common, more of these patients present to the emergency department postoperatively. The most common complaints in these patients are abdominal pain, nausea, and vomiting, though each of the surgical procedures will present with specific complications, and management will vary according to the surgical procedure performed. Computed tomography is often the primary imaging modality, though it has it limits, and plain film imaging is appropriate in some cases. This review presents an overview of the various bariatric procedures, highlighting the potential complications of each, both surgical and nonsurgical, and provides evidence-based recommendations regarding patient management and disposition.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Medicina de Emergência/métodos , Complicações Pós-Operatórias/terapia , Cirurgia Bariátrica/métodos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/tendências , Humanos , Pacientes , Complicações Pós-Operatórias/fisiopatologia
13.
West J Emerg Med ; 20(3): 428-432, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31123541

RESUMO

Introduction: Opioid abuse has reached epidemic proportions in the United States. Patients often present to the emergency department (ED) with painful conditions seeking analgesic relief. While there is known variability in the prescribing behaviors of emergency physicians, it is unknown if there are differences in these behaviors based on training level or by resident specialty. Methods: This is a retrospective chart review of ED visits from a single, tertiary-care academic hospital over a single academic year (2014-2015), examining the amount of opioid pain medication prescribed. We compared morphine milligram equivalents (MME) between provider specialty and level of training (emergency medicine [EM] attending physicians, EM residents in training, and non-EM residents in training). Results: We reviewed 55,999 total ED visits, of which 4,431 (7.9%) resulted in discharge with a prescription opioid medication. Residents in a non-EM training program prescribed higher amounts of opioid medication (108 MME, interquartile ratio [IQR] 75-150) than EM attendings (90 MME, lQR 75-120), who prescribed more than residents in an EM training program (75 MME, IQR 60-113) (p<0.01). Conclusion: In an ED setting, variability exists in prescribing patterns with non-EM residents prescribing larger amounts of opioids in the acute setting. EM attendings should closely monitor for both over- and under-prescribing of analgesic medications.


Assuntos
Analgésicos Opioides , Medicina de Emergência , Internato e Residência , Morfina/administração & dosagem , Transtornos Relacionados ao Uso de Opioides , Manejo da Dor , Adulto , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Prescrições de Medicamentos/estatística & dados numéricos , Educação/métodos , Medicina de Emergência/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Internato e Residência/classificação , Internato e Residência/métodos , Masculino , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Estudos Retrospectivos , Estados Unidos/epidemiologia
14.
Medicine (Baltimore) ; 98(18): e15406, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045795

RESUMO

BACKGROUND: Traumatic vascular injury is caused by explosions and projectiles (bullets and shrapnel); it may affect the arteries and veins of the limbs, and is common in wartime, triggering bleeding, and ischemia. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. METHODS: To summarize the current evidence of diagnosis and treatment for traumatic vascular injury of limbs, for saving limbs and lives, and put forward some new insights, we comprehensively consulted literatures and analyzed progress in injury diagnosis and wound treatment, summarized the advanced treatments now available, especially in wartime, and explored the principal factors in play in an effort to optimize clinical outcomes. RESULTS: Extremity vascular trauma poses several difficult dilemmas in diagnosis and treatment. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. Any delay in treatment may lead to loss of limbs or death. The development of diagnose and treat vascular injury of extremities are the clinical significance to the tip of military medicine, such as the use of fast, cheap, low invasive diagnostic methods, repairing severe vascular injury as soon as possible, using related technologies actively (fasciotomy, etc). CONCLUSION: We point out the frontier of the diagnosis and treatment of traumatic vascular injury, also with a new model of wartime injury treatment in American (forward surgical teams and combat support hospitals), French military surgeons regarding management of war-related vascular wounds and Chinese military ("3 districts and 7 grades" model). Many issues remain to be resolved by further experience and investigation.


Assuntos
Medicina de Emergência/métodos , Extremidades , Medicina Militar/métodos , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/terapia , Amputação/métodos , Índice Tornozelo-Braço , Traumatismos por Explosões/diagnóstico , Traumatismos por Explosões/terapia , Prótese Vascular , Descompressão Cirúrgica/métodos , Fasciotomia/métodos , Fraturas Ósseas/terapia , Humanos , Militares , Estudos Retrospectivos , Transplante de Pele/métodos , Fatores de Tempo , Índices de Gravidade do Trauma , Estados Unidos , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular/diagnóstico por imagem
15.
Int Emerg Nurs ; 45: 17-24, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31053392

RESUMO

BACKGROUND: Research exploring multi-disciplinary emergency department (ED) clinicians' perceptions of their working environment is limited, although exposure to occupational stressors is frequent. This study describes ED clinicians' perceptions of their working environment, occupational stressors and their use of coping strategies. METHODS: A cross-sectional descriptive study was conducted in 2017 at two Australian public hospital EDs. Nursing and medical staff completed a print-based survey of 100 items, which included three scales and a demographic questionnaire. Responses were analysed using descriptive statistics and regression analysis. RESULTS: Doctors and nurses (n = 241) completed the survey (response rate 45%). Workload featured as a major factor in perception of the working environment and was a frequently occurring stressor. Death or sexual abuse of a child was the highest rated stressor, despite relative infrequency of exposure. When coping strategies were adjusted for sex, female respondents were more likely to use negative strategies such as blaming themselves (Odds Ratio, OR 4 [1.6-9.7]; p < 0.01) and less likely to use positive strategies such as exercise (OR 0.2 [0.1-0.6]; p < 0.01). CONCLUSIONS: While stressors were similarly rated among the diverse group of clinicians, the ways in which they reported coping varied. Further research is required to facilitate design of staff support strategies.


Assuntos
Adaptação Psicológica , Pessoal de Saúde/psicologia , Estresse Ocupacional/psicologia , Adulto , Estudos Transversais , Medicina de Emergência/métodos , Medicina de Emergência/tendências , Enfermagem em Emergência/métodos , Enfermagem em Emergência/tendências , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/terapia , Razão de Chances , Inquéritos e Questionários , Local de Trabalho/psicologia , Local de Trabalho/normas
16.
Support Care Cancer ; 27(8): 3147-3157, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31076900

RESUMO

PURPOSE: Most cancer patients experience many pain episodes depending on disruptive elements, leading them to the emergency room. The objective of the article is to describe common pitfalls that need to be avoided, as well as opportunities to be seized for repositioning patients back on their care pathway. METHODS: Critical reflection based on literature analysis and clinical practice. RESULTS: Most forms of cancer are now chronic, evolving diseases, and patients are treated with high-technology targeted therapies with iatrogenic effects. Moreover, the multimorphic nature of cancer-related pain requires dynamic, interdisciplinary assessments addressing its etiology, its pathophysiology, its dimensions (sensory-discriminatory, cognitive, emotional, and behavioral), and the patient's perception of it, in order to propose the most adapted therapies. However, for most patients, cancer pain remains underestimated, poorly assessed, and under-treated. In this context, the key steps in emergency cancer pain management are as follows: • Quick relief of uncontrolled cancer pain: after eliminating potential medical or surgical emergencies revealed by pain, a brief questioning will make the use of carefully titrated morphine in most situations possible. • Assessment and re-assessment of the pain and the patient, screening specific elements, to better understand the situation and its consequences. • Identification of disruptive elements leading to uncontrolled pain, with an interdisciplinary confrontation to find a mid to long-term approach, involving the appropriate pharmaceutical and/or non-pharmaceutical strategies, possibly including interventions. CONCLUSIONS: Pain emergencies should be part of the cancer care pathway and, through supportive care, provide an opportunity to help cancer patients both maintain their physical, psychological, and social balance and anticipate further painful episodes.


Assuntos
Dor do Câncer/terapia , Medicina de Emergência/métodos , Manejo da Dor/métodos , Humanos
17.
Emerg Med J ; 36(6): 346-354, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31097464

RESUMO

OBJECTIVES: Shared decision-making (SDM) is receiving increasing attention in emergency medicine because of its potential to increase patient engagement and decrease unnecessary healthcare utilisation. This study sought to explore physician-identified barriers to and facilitators of SDM in the ED. METHODS: We conducted semistructured interviews with practising emergency physicians (EP) with the aim of understanding when and why EPs engage in SDM, and when and why they feel unable to engage in SDM. Interviews were transcribed verbatim and a three-member team coded all transcripts in an iterative fashion using a directed approach to qualitative content analysis. We identified emergent themes, and organised themes based on an integrative theoretical model that combined the theory of planned behaviour and social cognitive theory. RESULTS: Fifteen EPs practising in the New England region of the USA were interviewed. Physicians described the following barriers: time constraints, clinical uncertainty, fear of a bad outcome, certain patient characteristics, lack of follow-up and other emotional and logistical stressors. They noted that risk stratification methods, the perception that SDM decreased liability and their own improving clinical skills facilitated their use of SDM. They also noted that the culture of the institution could play a role in discouraging or promoting SDM, and that patients could encourage SDM by specifically asking about alternatives. CONCLUSIONS: EPs face many barriers to using SDM. Some, such as lack of follow-up, are unique to the ED; others, such as the challenges of communicating uncertainty, may affect other providers. Many of the barriers to SDM are amenable to intervention, but may be of variable importance in different EDs. Further research should attempt to identify which barriers are most prevalent and most amenable to intervention, as well as capitalise on the facilitators noted.


Assuntos
Relações Médico-Paciente , Médicos/psicologia , Adulto , Idoso , Atitude do Pessoal de Saúde , Medicina de Emergência/métodos , Medicina de Emergência/normas , Serviço Hospitalar de Emergência/organização & administração , Feminino , Grupos Focais/métodos , Humanos , Masculino , Pessoa de Meia-Idade , New England , Participação do Paciente/psicologia , Pesquisa Qualitativa
18.
Medicine (Baltimore) ; 98(17): e15315, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027099

RESUMO

We examined whether and how conferences on cases of medico-legal autopsy after emergency medicine (EM) practices improved the diagnostic accuracy and expertise of emergency medicine practitioners (EMPs) and forensic pathologists (FPs); we also examined the necessity of imaging in autopsy diagnoses. We additionally discuss whether imaging could replace autopsy.An unsigned, self-administered questionnaire was distributed to the attendees of monthly case conferences during which EMPs and FPs discussed EM-associated autopsy cases. The questionnaire addressed the following 6 questions: was the conference useful for forensic medicine or EM practices, was autopsy necessary for each case, were the autopsy and clinical diagnoses consistent, was imaging necessary for autopsy diagnosis, and should autopsy results be disclosed to the public. Participants were autopsy operators, third-party EMPs, and FPs, primarily from universities in and near Tokyo.Fifty-two cases were discussed; more than 80% of the attendees acknowledged the usefulness of autopsy and the conferences, and 33.6% corrected their diagnoses by considering autopsy information. Major clinical misdiagnoses were corrected by autopsy in 35.3% of cases, including procedure-related hemorrhage, intoxication, asphyxia, fat embolism, diabetes, organ injuries, and subarachnoid hemorrhage (SAH). Approximately 75% of the attendees recognized the usefulness of imaging for autopsy. However, in a series of four SAH cases, the clinical diagnoses were corrected after the conferences more often by EMPs than by FPs. In a violence-related case, false legal judgment was prevented because the conference discussion corrected the clinical diagnosis from traumatic to natural.In conclusion, the conference improved the accuracy and expertise of diagnoses provided by EMPs and FPs; conference participation led to the correction of major clinical misdiagnoses as well as that of the first diagnoses issued by attendees in more than one-third cases. The usefulness of imaging for autopsy was acknowledged by two thirds of the attendees. Our results also suggested that imaging cannot replace autopsy in deaths related to procedure or violence and in several categories of deaths such as intoxication and asphyxia.


Assuntos
Autopsia/métodos , Causas de Morte , Medicina de Emergência/métodos , Patologia Legal/métodos , Humanos
19.
Emerg Med J ; 36(6): 364-368, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30940715

RESUMO

Resuscitation lacks a place in the hospital to call its own. Specialised intensive care units, though excellent at providing longitudinal critical care, often lack the flexibility to adapt to fluctuating critical care needs. We offer the resuscitative care unit as a potential solution to ensure that patients receive appropriate care during the most critical hours of their illnesses. These units offer an infrastructure for resuscitation and can meet the changing needs of their institutions.


Assuntos
Unidades de Terapia Intensiva/tendências , Ressuscitação/métodos , Centros Médicos Acadêmicos/organização & administração , Medicina de Emergência/métodos , Planejamento Ambiental/normas , Planejamento Ambiental/tendências , Humanos , Unidades de Terapia Intensiva/organização & administração , Maryland , Michigan , Pennsylvania , Ressuscitação/tendências
20.
J Med Internet Res ; 21(4): e12368, 2019 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-30994463

RESUMO

BACKGROUND: Augmented reality is increasingly being investigated for its applications to medical specialties as well as in medical training. Currently, there is little information about its applicability to training and care delivery in the context of emergency medicine. OBJECTIVE: The objective of this article is to review current literature related to augmented reality applicable to emergency medicine and its training. METHODS: Through a scoping review utilizing Scopus, MEDLINE, and Embase databases for article searches, we identified articles involving augmented reality that directly involved emergency medicine or was in an area of education or clinical care that could be potentially applied to emergency medicine. RESULTS: A total of 24 articles were reviewed in detail and were categorized into three groups: user-environment interface, telemedicine and prehospital care, and education and training. CONCLUSIONS: Through analysis of the current literature across fields, we were able to demonstrate that augmented reality has utility and feasibility in clinical care delivery in patient care settings, in operating rooms and inpatient settings, and in education and training of emergency care providers. Additionally, we found that the use of augmented reality for care delivery over distances is feasible, suggesting a role in telehealth. Our results from the review of the literature in emergency medicine and other specialties reveal that further research into the uses of augmented reality will have a substantial role in changing how emergency medicine as a specialty will deliver care and provide education and training.


Assuntos
Realidade Aumentada , Assistência à Saúde/métodos , Medicina de Emergência/métodos , Humanos
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