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1.
South. Afr. j. anaesth. analg. (Online) ; 29(4): 144-150, 2023. tables
Artigo em Inglês | AIM (África) | ID: biblio-1511931

RESUMO

Resuscitation trolleys with equipment and medicines for emergencies are required in all clinical areas in hospitals. Emergency medicines kept separately are more likely to expire than non-emergency medicines, as these are generally used less frequently. An updated list of essential emergency medicines was implemented in 2016 at an academic hospital in central South Africa. The aim of this study was to determine the frequency of both the use and the expiry, with associated financial losses, of the emergency medicines on this list. Methods: A prospective, descriptive study was conducted over a six-month period in 2019. Forms accompanying the emergency packs were returned to the pharmacy whenever packs expired or were opened. These forms were collected and the type and quantity of medicines either used or expired were recorded. Results: In total, 168 of the returned forms were included. The most frequently used emergency medicines were adrenaline, sodium bicarbonate and Ringer's lactate. Adrenaline use was recorded on 52.8% and 25% of the forms from the adult/paediatric and neonatal emergency packs, respectively. Medicines that were never used included: betamethasone, Darrow's half-strength solution and most of the neonatal pack medications. Neonatal emergency medicine packs were rarely used and the neonatal fluid packs were never used. The total cost of the expired medicines was R7 960.29 (US$569.41 at the time of the study). Adrenaline was the medication that expired most frequently but the greatest financial losses occurred from expired sodium bicarbonate. Conclusion: The total financial losses were low but can be reduced further. The contents of the emergency packs should be reviewed to possibly reduce the amount of items used infrequently. Also, the removal of those items not recommended in emergency care guidelines could be considered. Ensuring the policy was followed of returning unused medicines close to expiry and redistributing these to high-use areas would further reduce wastage


Assuntos
Humanos , Epinefrina , Medicina de Emergência Baseada em Evidências , Preparações Farmacêuticas , Auxiliares de Emergência , Medicina de Emergência
3.
Emerg Med J ; 39(3): 237-238, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35190394

RESUMO

A short-cut review of the available medical literature was carried out to establish whether elbow immobilisation is required after closed reduction of a distal radial fracture. After abstract review, six papers were found to answer this clinical question using the detailed search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that elbow immobilisation is not required.


Assuntos
Fratura de Colles , Medicina de Emergência Baseada em Evidências , Humanos
4.
Emerg Med J ; 39(2): 157-158, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35058292

RESUMO

A short-cut review of the available medical literature was carried out to establish whether CT scanning can rule out cerebellar infarction. After abstract review, two papers were found to answer this clinical question using the detailed search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that there is insufficient evidence to draw a conclusion.


Assuntos
Serviço Hospitalar de Emergência , Medicina de Emergência Baseada em Evidências , Humanos , Infarto , Tomografia Computadorizada por Raios X
5.
Washington, D.C.; PAHO; 2022-01-26. (PAHO/IMS/EIH/COVID-19/22-0010).
Não convencional em Inglês | PAHO-IRIS | ID: phr-52719

RESUMO

This document includes the results of a rapid systematic review of current available literature. The information included in this review reflects the evidence as of the date posted in the document. In recognition of the fact that there are numerous ongoing clinical studies, PAHO will periodically update this review and corresponding recommendations as new evidence becomes available.


Assuntos
COVID-19 , Coronavirus , Infecções por Coronavirus , Betacoronavirus , Pandemias , Medicina de Emergência Baseada em Evidências
7.
Emerg Med J ; 38(5): 401-403, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34449416

RESUMO

A short-cut review of the available medical literature was carried out to establish whether homemade or cloth face masks can prevent respiratory virus transmission or clinical illness. After abstract review, twelve papers were found to answer this clinical question using the detailed search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that there is currently no direct evidence to support the use of homemade or cloth masks by the general public for protection against viral infections.


Assuntos
Máscaras/estatística & dados numéricos , Infecções Respiratórias/prevenção & controle , Viroses/prevenção & controle , Medicina de Emergência Baseada em Evidências , Humanos
8.
Emerg Med J ; 38(8): 653-655, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34449435

RESUMO

A short-cut review of the literature was carried out to examine the diagnostic test characteristics and potential patient benefits through the use of the Ottawa Subarachnoid Haemorrhage Clinical Decision Rule. Nine papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. It is concluded that the Ottawa Clinical Decision Rule has a high sensitivity for the diagnosis of subarachnoid haemorrhage; however, there is limited robust evidence of international generalisability and no evidence of improved patient outcomes following implementation. Further prospective research is required in populations with variable prevalence to evaluate the safety and effectiveness of this intervention, compared with routine evaluation strategies.


Assuntos
Regras de Decisão Clínica , Hemorragia Subaracnóidea/diagnóstico , Diagnóstico Diferencial , Medicina de Emergência Baseada em Evidências , Humanos , Sensibilidade e Especificidade
9.
Emerg Med J ; 38(8): 655-656, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34449436

RESUMO

A short-cut review of the literature was carried out to examine the benefits of caffeine as an analgesic adjunct in tension-type and migraine-type headache. Six papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. It is concluded that caffeine provides effective analgesia as an adjunctive treatment in the management of secondary headache syndromes.


Assuntos
Cafeína/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Manejo da Dor/métodos , Cefaleia do Tipo Tensional/tratamento farmacológico , Medicina de Emergência Baseada em Evidências , Humanos
10.
CMAJ Open ; 9(1): E261-E270, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33731427

RESUMO

BACKGROUND: Emergency physicians lack high-quality evidence for many diagnostic and treatment decisions made for patients with suspected or confirmed coronavirus disease 2019 (COVID-19). Our objective is to describe the methods used to collect and ensure the data quality of a multicentre registry of patients presenting to the emergency department with suspected or confirmed COVID-19. METHODS: This methodology study describes a population-based registry that has been enrolling consecutive patients presenting to the emergency department with suspected or confirmed COVID-19 since Mar. 1, 2020. Most data are collected from retrospective chart review. Phone follow-up with patients at 30 days captures the World Health Organization clinical improvement scale and contextual, social and cultural variables. Phone follow-up also captures patient-reported quality of life using the Veterans Rand 12-Item Health Survey at 30 days, 60 days, 6 months and 12 months. Fifty participating emergency departments from 8 provinces in Canada currently enrol patients into the registry. INTERPRETATION: Data from the registry of the Canadian COVID-19 Emergency Department Rapid Response Network will be used to derive and validate clinical decision rules to inform clinical decision-making, describe the natural history of the disease, evaluate COVID-19 diagnostic tests and establish the real-world effectiveness of treatments and vaccines, including in populations that are excluded or underrepresented in clinical trials. This registry has the potential to generate scientific evidence to inform our pandemic response, and to serve as a model for the rapid implementation of population-based data collection protocols for future public health emergencies. TRIAL REGISTRATION: Clinicaltrials.gov, no. NCT04702945.


Assuntos
COVID-19 , Medicina de Emergência , Sistema de Registros , COVID-19/diagnóstico , COVID-19/terapia , Canadá , Confiabilidade dos Dados , Coleta de Dados , Gerenciamento de Dados , Serviço Hospitalar de Emergência , Medicina de Emergência Baseada em Evidências , Seguimentos , Humanos , Armazenamento e Recuperação da Informação , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , SARS-CoV-2 , Telefone
11.
Emerg Med Pract ; 23(2): 1-24, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33476506

RESUMO

As recommendations for the diagnosis, treatment, and disposition of patients with community-acquired pneumonia continue to evolve, this issue reviews the current evidence and guidelines for managing these patients in the emergency department. The various clinical decision aids are compared, as they assist in determining the level of inpatient care required and allow for a greater proportion of patients to be treated successfully as outpatients. A clinical pathway for emergency department management delineates optimal antibiotic regimens based on severity, comorbidities, and risk factors.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/terapia , Serviço Hospitalar de Emergência , Medicina de Emergência Baseada em Evidências , Pneumonia/diagnóstico , Pneumonia/terapia , Humanos
12.
Emerg Med J ; 38(1): 78-79, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33372045

RESUMO

A shortcut review was carried out to see whether the hook test is sensitive enough for a negative result to exclude complete distal biceps tendon rupture (DBTR) in adults. 3 papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that the hook test is moderately sensitive at detecting complete DBTR when carried out by skilled clinicians in specialist upper limb clinics. As a single test, it is not sensitive enough to be used to exclude complete DBTR.


Assuntos
Traumatismos do Braço/diagnóstico , Exame Físico/métodos , Traumatismos dos Tendões/diagnóstico , Diagnóstico Diferencial , Medicina de Emergência Baseada em Evidências , Humanos , Ruptura , Sensibilidade e Especificidade
13.
Emerg Med J ; 38(1): 79-80, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33372046

RESUMO

A shortcut review was carried out to investigate whether avulsion fractures of the base of the fifth metatarsal were best treated with tubular bandage, a walking boot or a short leg plaster cast. One paper presented the only evidence to answer one of the clinical questions (plaster cast or walking boot) but no evidence was found comparing tubular bandage and a walking boot. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are tabulated. It is concluded that while the only evidence available shows marginal benefit of walking boot over short plaster cast during recovery, there is no benefit to final outcome. Further research comparing tubular bandage and walking boot is required.


Assuntos
Bandagens , Moldes Cirúrgicos , Órtoses do Pé , Fratura Avulsão/terapia , Ossos do Metatarso/lesões , Medicina de Emergência Baseada em Evidências , Humanos
14.
J Emerg Nurs ; 47(1): 113-122, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33221035

RESUMO

INTRODUCTION: ED visits for gastrostomy tube-related complications are common, and many are related to tube displacement. Evidence-based practices can provide standardized care. METHODS: This study was an evidence-based project to develop and implement an algorithm for the care of patients with a displaced gastrostomy tube in the emergency department. Providers were educated on the algorithm, and clinical practice change was evaluated. Provider knowledge was assessed using pretest and posttest; analyses included paired t test. Descriptive statistics of electronic medical record data on confirmation method, documentation, and referral were reported. RESULTS: Provider knowledge was improved after the education (n = 22; t(21) = -3.80; P = 0.001). After the education, procedure notes were used and completed in 95% of the cases. Appropriate use of the confirmation method was present in 95% of the cases, and all cases were referred to the gastrostomy/specialty clinic. DISCUSSION: Educating providers regarding care for displaced gastrostomy tubes increased their knowledge. A standardized algorithm improved care by decreasing the use of contrast studies, improving documentation, and referring patients to the gastrostomy/specialty clinic. This evidence-based algorithm offered health care providers a protocol to ensure consistent care for children in the emergency department and support for families.


Assuntos
Algoritmos , Serviço Hospitalar de Emergência , Medicina de Emergência Baseada em Evidências/educação , Gastrostomia/efeitos adversos , Melhoria de Qualidade , Criança , Avaliação Educacional , Hospitais Comunitários , Humanos
15.
Emerg Med Pract ; 22(Suppl 12): 1-43, 2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320488

RESUMO

Blunt cerebrovascular injuries include cervical carotid dissections and vertebral artery dissections that are due to blunt trauma. Although the overall incidence is low, dissections remain a common cause of stroke in children, young adults, and trauma patients. Symptoms of dissection, such as headache, neck pain, and dizziness, are commonly seen in the emergency department, but may not be apparent in the obtunded trauma patient or may not be recognized as being due to a dissection. A missed diagnosis of cervical artery dissection can result in devastating neurologic sequelae, and emergency clinicians must act quickly to recognize this diagnosis and begin treatment as soon as possible. This supplement reviews the application of advanced screening criteria, imaging options, and antithrombotic treatment for patients with blunt cerebrovascular injuries, with a focus on reducing the occurrence of ischemic stroke.


Assuntos
Traumatismos Craniocerebrais/complicações , Serviço Hospitalar de Emergência , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Ferimentos não Penetrantes/complicações , Anticoagulantes/uso terapêutico , Dissecação da Artéria Carótida Interna/complicações , Dissecação da Artéria Carótida Interna/diagnóstico , Dissecação da Artéria Carótida Interna/tratamento farmacológico , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/tratamento farmacológico , Diagnóstico Diferencial , Diagnóstico por Imagem , Diagnóstico Precoce , Medicina de Emergência Baseada em Evidências , Humanos , Anamnese , Exame Físico , Fatores de Risco , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/diagnóstico , Dissecação da Artéria Vertebral/tratamento farmacológico , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/tratamento farmacológico
17.
Emerg Med Pract ; 22(12): 1-20, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33211443

RESUMO

Rhabdomyolysis is a life-threatening pathological process that must be treated as early as possible to avoid potentially life-threatening sequelae. Much of the evidence that informs the management of rhabdomyolysis is retrospective research, often reported from mass disasters, and many practices that have been implemented as standard treatment are based on small studies published more than 30 years ago. This issue reviews the current literature on rhabdomyolysis and provides recommendations for each phase of care, from the prehospital setting through disposition. The evidence is examined regarding the variety of therapies that are used to manage rhabdomyolysis, the potential for recognizing a genetic predisposition for the condition, and therapeutic recommendations that improve patient outcomes.


Assuntos
Serviço Hospitalar de Emergência , Medicina de Emergência Baseada em Evidências , Rabdomiólise/diagnóstico , Rabdomiólise/terapia , Diagnóstico Diferencial , Humanos
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