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1.
PLoS One ; 15(8): e0237751, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817673

RESUMO

BACKGROUND: In the developed world, cardiovascular diseases still contribute to mortality and morbidity, leading to significantly increased deaths in recent years. Thus, it is necessary for a layperson to provide the best possible basic life support (BLS) until professional help is available. Since information on current BLS knowledge in Germany is not available, but necessary to be able to make targeted improvements in BLS education, we conducted this study. METHODS: A cohort survey using convenience sampling (non-probability) method was conducted with questions found in emergency medicine education. People coming to the emergency room of two big university hospitals located in the South (Munich) and western part (Cologne) of Germany were asked to participate in the survey between 2016 and 2017. Primary outcome measures were the proportion of correct answers for each emergency scenario in relationship to age, region, profession and first-aid training. RESULTS: Altogether 1003 people (504 from Cologne; 499 from Munich) took part in the questionnaire. 54.7% were female and 45.3% were male aging from 19 to 52 with a mean of 37.2 years. Although over 90% had taken part in first aid training, many people were lacking first aid knowledge, with less than 10% choosing the correct frequency for chest compression. Hereby demographic factors had a significant influence (p<0.05) in the given answers (Friedmann-and-Wilcoxon Test). CONCLUSION: Overall, results of our survey indicate a clear lack of BLS knowledge. With this information, targeted measures for improving BLS knowledge should be conducted. Additionally, further studies on the feasibility and efficiency of teaching methods are needed.


Assuntos
Reanimação Cardiopulmonar/métodos , Doenças Cardiovasculares/prevenção & controle , Emergências/epidemiologia , Medicina de Emergência/normas , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/patologia , Feminino , Alemanha/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
2.
Ann Emerg Med ; 76(3): e13-e39, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32828340

RESUMO

This clinical policy from the American College of Emergency Physicians addresses key issues in opioid management in adult patients presenting to the emergency department. A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical questions: (1) In adult patients experiencing opioid withdrawal, is emergency department-administered buprenorphine as effective for the management of opioid withdrawal compared with alternative management strategies? (2) In adult patients experiencing an acute painful condition, do the benefits of prescribing a short course of opioids on discharge from the emergency department outweigh the potential harms? (3) In adult patients with an acute exacerbation of noncancer chronic pain, do the benefits of prescribing a short course of opioids on discharge from the emergency department outweigh the potential harms? (4) In adult patients with an acute episode of pain being discharged from the emergency department, do the harms of a short concomitant course of opioids and muscle relaxants/sedative-hypnotics outweigh the benefits? Evidence was graded and recommendations were made based on the strength of the available data.


Assuntos
Analgésicos Opioides/administração & dosagem , Medicina de Emergência/normas , Serviço Hospitalar de Emergência/normas , Padrões de Prática Médica/normas , Humanos , Guias de Prática Clínica como Assunto , Sociedades Médicas , Estados Unidos
3.
J Med Internet Res ; 22(7): e19126, 2020 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-32716313

RESUMO

BACKGROUND: Information overload is affecting modern society now more than ever because of the wide and increasing distribution of digital technologies. Social media, emails, and online communications among others infuse a sense of urgency as information must be read, produced, and exchanged almost instantaneously. Emergency medicine is a medical specialty that is particularly affected by information overload with consequences on patient care that are difficult to quantify and address. Understanding the current causes of medical information overload, their impact on patient care, and strategies to handle the inflow of constant information is crucial to alleviating stress and anxiety that is already crippling the profession. OBJECTIVE: This study aims to identify and evaluate the main causes and sources of medical information overload, as experienced by emergency medicine physicians in selected National Health Service (NHS) trusts in the United Kingdom. METHODS: This study used a quantitative, survey-based data collection approach including close- and open-ended questions. A web-based survey was distributed to emergency physicians to assess the impact of medical information overload on their jobs. In total, 101 valid responses were collected from 4 NHS trusts in north England. Descriptive statistics, principal component analysis, independent sample two-tailed t tests, and one-way between-group analysis of variance with post hoc tests were performed on the data. Open-ended questions were analyzed using thematic analysis to identify key topics. RESULTS: The vast majority of respondents agreed that information overload is a serious issue in emergency medicine, and it increases with time. The always available culture (mean 5.40, SD 1.56), email handling (mean 4.86, SD 1.80), and multidisciplinary communications (mean 4.51, SD 1.61) are the 3 main reasons leading to information overload. Due to this, emergency physicians experience guideline fatigue, stress and tension, longer working hours, and impaired decision making, among other issues. Aspects of information overload are also reported to have different impacts on physicians depending on demographic factors such as age, years spent in emergency medicine, and level of employment. CONCLUSIONS: There is a serious concern regarding information overload in emergency medicine. Participants identified a considerable number of daily causes affecting their job, particularly the traditional culture of emergency departments being always available on the ward, exacerbated by email and other forms of communication necessary to maintain optimal, evidence-based practice standards. However, not all information is unwelcome, as physicians also need to stay updated with the latest guidelines on conditions and treatment, and communicate with larger medical teams to provide quality care.


Assuntos
Processamento Eletrônico de Dados/métodos , Medicina de Emergência/normas , Médicos/normas , Adulto , Inglaterra , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
4.
Scand J Trauma Resusc Emerg Med ; 28(1): 68, 2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32678052

RESUMO

INTRODUCTION: In emergency care, geriatric requirements and risks are often not taken sufficiently into account. In addition, there are neither evidence-based recommendations nor scientifically developed quality indicators (QI) for geriatric emergency care in German emergency departments. As part of the GeriQ-ED© research project, quality indicators for geriatric emergency medicine in Germany have been developed using the QUALIFY-instruments. METHODS: Using a triangulation methodology, a) clinical experience-based quality aspects were identified and verified, b) research-based quality statements were formulated and assessed for relevance, and c) preliminary quality indicators were operationalized and evaluated in order to recommend a feasible set of final quality indicators. RESULTS: Initially, 41 quality statements were identified and assessed as relevant. Sixty-seven QI (33 process, 29 structure and 5 outcome indicators) were extrapolated and operationalised. In order to facilitate implementation into daily practice, the following five quality statements were defined as the GeriQ-ED© TOP 5: screening for delirium, taking a full medications history including an assessment of the indications, education of geriatric knowledge and skills to emergency staff, screening for patients with geriatric needs, and identification of patients with risk of falls/ recurrent falls. DISCUSSION: QIs are regarded as gold standard to measure, benchmark and improve emergency care. GeriQ-ED© QI focused on clinical experience- and research-based recommendations and describe for the first time a standard for geriatric emergency care in Germany. GeriQ-ED© TOP 5 should be implemented as a minimum standard in geriatric emergency care.


Assuntos
Medicina de Emergência/normas , Serviço Hospitalar de Emergência , Avaliação Geriátrica , Geriatria/normas , Indicadores de Qualidade em Assistência à Saúde , Acidentes por Quedas/prevenção & controle , Idoso , Delírio/diagnóstico , Técnica Delfos , Humanos , Capacitação em Serviço , Programas de Rastreamento/normas , Reconciliação de Medicamentos , Determinação de Necessidades de Cuidados de Saúde , Melhoria de Qualidade , Medição de Risco
9.
West J Emerg Med ; 21(3): 555-565, 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32421501

RESUMO

Medicine recognizes burnout as a threat to quality patient care and physician quality of life. This issue exists throughout medicine but is notably prevalent in emergency medicine (EM). Because the concept of "wellness" lacks a clear definition, attempts at ameliorating burnout that focus on achieving wellness make success difficult to achieve and measure. Recent work within the wellness literature suggests that the end goal should be to achieve a culture of wellness by addressing all aspects of the physician's environment. A review of the available literature on burnout and wellness interventions in all medical specialties reveals that interventions focusing on individual physicians have varying levels of success. Efforts to compare these interventions are hampered by a lack of consistent endpoints. Studies with consistent endpoints do not demonstrate clear benefits of achieving them because improving scores on various scales may not equate to improvement in quality of care or physician quality of life. Successful interventions have uncertain, long-term effects. Outside of EM, the most successful interventions focus on changes to systems rather than to individual physicians. Within EM, the number of well-structured interventions that have been studied is limited. Future work to achieve the desired culture of wellness within EM requires establishment of a consistent endpoint that serves as a surrogate for clinical significance, addressing contributors to burnout at all levels, and integrating successful interventions into the fabric of EM.


Assuntos
Esgotamento Profissional , Medicina de Emergência , Médicos/psicologia , Qualidade da Assistência à Saúde/organização & administração , Qualidade de Vida , Esgotamento Profissional/etiologia , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , Medicina de Emergência/métodos , Medicina de Emergência/normas , Humanos , Cultura Organizacional , Objetivos Organizacionais , Psicologia
10.
AJOB Empir Bioeth ; 11(3): 148-159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369433

RESUMO

Background: The COVID-19 pandemic has highlighted health care systems' vulnerabilities. Hospitals face increasing risk of periods of scarcity of life-sustaining resources such as ventilators for mechanical respiratory support, as has been the case in Italy as of March, 2020. The National Academy of Medicine has provided guidance on crisis standards of care, which call for the reallocation of scarce medical resources to those who will benefit most during extreme situations. Given that this will require a departure from the usual fiduciary duty of the bedside clinician, we determined and mapped potential barriers to the implementation of the guidelines from stakeholders using an implementation science framework. Methods: A protocol was created to operationalize national and state guidelines for triaging ventilators during crisis conditions. Focus groups and key informant interviews were conducted from July-September 2018 with clinicians at three acute care hospitals of an urban academic medical center. Respiratory therapists, intensivists, nursing leadership and the palliative care interdisciplinary team participated in focus groups. Key informant interviews were conducted with emergency management, respiratory therapy and emergency medicine. Subjects were presented the protocol and their reflections were elicited using a semi-structured interview guide. Data from transcripts and notes were categorized using a coding strategy based on the Theoretical Domains Framework. Results: Participants anticipated that implementing this protocol would challenge their roles and identities as clinicians including both their fiduciary duty to the patient and their decision-making autonomy. Despite this, many participants acknowledged the need for such a protocol to standardize care and minimize bias as well as to mitigate potential consequences for individual clinicians. Participants identified the question of considering patient quality of life in triage decisions as an important and unresolved ethical issue in disaster triage. Conclusion: Clinicians' discomfort with shifting roles and obligations could pose implementation barriers for crisis standards of care.


Assuntos
Atitude do Pessoal de Saúde , Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/normas , Pneumonia Viral/terapia , Padrão de Cuidado , Suspensão de Tratamento/ética , Centros Médicos Acadêmicos , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/ética , Medicina de Emergência/normas , Grupos Focais , Humanos , Entrevistas como Assunto , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Qualidade de Vida , Respiração Artificial/normas , Terapia Respiratória/normas , Padrão de Cuidado/ética , Triagem/métodos , Triagem/normas
12.
Eur J Emerg Med ; 27(3): 174-177, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-142684

RESUMO

The 2019 novel coronavirus acute respiratory epidemic is creating a stressed situation in all the health systems of the affected countries. Emergency medical systems and specifically the emergency departments as the front line of the health systems are suffering from overload and severe working conditions, the risk of contagion and transmission of the health professionals adds a substantial burden to their daily work. Under the perspective of European Society For Emergency Medicine, the recommendations provided by the health authorities are reviewed focus on the emergency department's activity.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Medicina de Emergência/normas , Serviço Hospitalar de Emergência/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Betacoronavirus , Humanos , Controle de Infecções , Pandemias , Isolamento de Pacientes , Equipamento de Proteção Individual/provisão & distribução , Triagem
13.
West J Emerg Med ; 21(3): 538-541, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: covidwho-72833

RESUMO

The Council of Residency Directors in Emergency Medicine (CORD) Advising Students Committee in Emergency Medicine (ASC-EM) anticipates institutional and regional variability in both the spread and response to COVID-19. Travel restrictions and host institution rotation closures will impact the number of emergency medicine (EM) rotations EM-bound medical students can complete in an unprecedented manner. They may prevent students from completing any away rotations this academic cycle, challenging the students' ability to obtain EM Standardized Letters of Evaluation (SLOEs). EM's emphasis on residency group SLOEs over other letter types creates an undue burden on these vulnerable students and makes the application process intrinsically inequitable. This inequity warrants a reevaluation of the current application practice. This article outlines ASC-EM's proposed recommendations for all stakeholders, including EM program leadership, medical schools, and EM-bound medical students, to consider for the upcoming EM application cycle.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Medicina de Emergência/educação , Internato e Residência/métodos , Pandemias , Pneumonia Viral , Viagem , Competência Clínica/normas , Medicina de Emergência/normas , Humanos , Política Organizacional , Faculdades de Medicina , Estudantes de Medicina , Estados Unidos
15.
Eur J Emerg Med ; 27(3): 174-177, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32243317

RESUMO

The 2019 novel coronavirus acute respiratory epidemic is creating a stressed situation in all the health systems of the affected countries. Emergency medical systems and specifically the emergency departments as the front line of the health systems are suffering from overload and severe working conditions, the risk of contagion and transmission of the health professionals adds a substantial burden to their daily work. Under the perspective of European Society For Emergency Medicine, the recommendations provided by the health authorities are reviewed focus on the emergency department's activity.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Medicina de Emergência/normas , Serviço Hospitalar de Emergência/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Betacoronavirus , Humanos , Controle de Infecções , Pandemias , Isolamento de Pacientes , Equipamento de Proteção Individual/provisão & distribução , Triagem
16.
West J Emerg Med ; 21(3): 538-541, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32302281

RESUMO

The Council of Residency Directors in Emergency Medicine (CORD) Advising Students Committee in Emergency Medicine (ASC-EM) anticipates institutional and regional variability in both the spread and response to COVID-19. Travel restrictions and host institution rotation closures will impact the number of emergency medicine (EM) rotations EM-bound medical students can complete in an unprecedented manner. They may prevent students from completing any away rotations this academic cycle, challenging the students' ability to obtain EM Standardized Letters of Evaluation (SLOEs). EM's emphasis on residency group SLOEs over other letter types creates an undue burden on these vulnerable students and makes the application process intrinsically inequitable. This inequity warrants a reevaluation of the current application practice. This article outlines ASC-EM's proposed recommendations for all stakeholders, including EM program leadership, medical schools, and EM-bound medical students, to consider for the upcoming EM application cycle.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Medicina de Emergência/educação , Internato e Residência/métodos , Pandemias , Pneumonia Viral , Viagem , Competência Clínica/normas , Medicina de Emergência/normas , Humanos , Política Organizacional , Faculdades de Medicina , Estudantes de Medicina , Estados Unidos
17.
Acad Emerg Med ; 27(7): 618-629, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32176420

RESUMO

Mechanical circulatory support is increasingly used as a long-term treatment option for patients with end-stage heart failure. Patients with implanted ventricular assist devices are at high risk for a range of diverse medical urgencies and emergencies. Given the increasing prevalence of mechanical circulatory support devices, this expert clinical consensus document seeks to help inform emergency medicine and prehospital providers regarding the approach to acute medical and surgical conditions encountered in these complex patients.


Assuntos
Medicina de Emergência/educação , Insuficiência Cardíaca/terapia , Coração Auxiliar/efeitos adversos , Consenso , Medicina de Emergência/normas , Humanos
19.
Br J Radiol ; 93(1106): 20190781, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31868522

RESUMO

OBJECTIVE: Sedation for pediatric patients undergoing interventional procedures in radiology is in increasing demand. Once only anesthesiology-performed, there is a demand for sedation services to perform sedations for these procedures. However, the safety of performing long sedations by non-anesthesiologists in interventional radiology has not been reported. This pilot study aimed at describing a single center's experience and outcome with sedation. METHODS: This study reviews the sedations performed at a single center by a pediatric emergency physician who performed the sedation. The results regarding safety and satisfaction were reviewed. RESULTS: A total of 52 sedations were documented. Four cases of significant adverse events and three adverse events occurred. In all cases, the procedures were completed. None of the patients required intubation or admission following the sedation. There was high satisfaction by the interventional radiologists. CONCLUSION: This small pilot study shows that sedations for procedures in interventional radiology can be performed safely and successfully by dedicated non-anesthesiology sedation services. This may be considered as an alternative when anesthesiology service is not available. ADVANCES IN KNOWLEDGE: This small, single center pilot study examines the safety of sedation by a non-anesthesiologist for interventional radiology procedures. This may offer an additional method of performing procedures in the pediatric population while anesthesia is not readily available.


Assuntos
Sedação Consciente/métodos , Medicina de Emergência/estatística & dados numéricos , Malformações Vasculares/cirurgia , Adolescente , Anestesiologistas , Criança , Pré-Escolar , Sedação Consciente/efeitos adversos , Medicina de Emergência/normas , Métodos Epidemiológicos , Feminino , Humanos , Lactente , Masculino , Segurança do Paciente
20.
J Intensive Care Med ; 35(2): 187-190, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29088995

RESUMO

BACKGROUND: We aimed to assess the knowledge, attitudes, and perceptions of resident physicians regarding sepsis in general and the Surviving Sepsis Campaign Guidelines in particular. METHODS: After institutional review board approval, we surveyed internal medicine (IM) and emergency medicine (EM) house staff from 3 separate institutions. House staff were notified of the survey via e-mail from their residency director or chief resident. The survey was Internet-based (using http://www.surveymonkey.com ), voluntary, and anonymous. The Surviving Sepsis Campaign Guidelines were used to develop the survey. The survey was open between December 2015 and April 2016. No incentives for participation were given. Reminder e-mails were sent approximately every 3 to 4 weeks to all eligible participants. Comparisons of responses were evaluated using the N-1 2-proportion test. RESULTS: A total of 133 responses were received. These included 84 from IM house staff, 27 from EM house staff, and 22 who selected "other." Eighty (101/126) percent reported managing at least 1 patient with sepsis in the preceding 30 days, 85% (97/114) rated their knowledge of the Surviving Sepsis Guidelines as "very familiar" or at least "somewhat familiar," and 84% (91/108) believed their training in the diagnosis and management of sepsis was "excellent" or at least "good." However, 43% (47/108) reported not receiving any feedback on their treatment of patients with sepsis in the last 30 days, while 24% (26/108) received feedback once. Both IM and EM house staff received comparable rates of feedback (62% vs 48%, respectively; P = .21). For the 3 questions that directly tested knowledge of the guidelines, the scores of the IM and EM house staff were similar. Notably, <20% of both groups correctly identified diagnostic criteria for sepsis. CONCLUSION: Additional education of IM and EM house staff on the Surviving Sepsis Campaign Guidelines is warranted, along with more consistent feedback regarding their diagnosis and management of sepsis.


Assuntos
Cuidados Críticos/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Médicos/psicologia , Sepse/psicologia , Choque Séptico/psicologia , Adulto , Cuidados Críticos/métodos , Medicina de Emergência/métodos , Medicina de Emergência/normas , Feminino , Promoção da Saúde , Humanos , Medicina Interna/métodos , Medicina Interna/normas , Internato e Residência , Masculino , Guias de Prática Clínica como Assunto , Sepse/terapia , Choque Séptico/terapia , Inquéritos e Questionários
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