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Just the Facts: Assessing and managing soft tissue knee injuries in the Emergency Department. 就事论事:在急诊科评估和处理膝关节软组织损伤。
IF 2.4 Pub Date : 2024-11-01 Epub Date: 2024-08-10 DOI: 10.1007/s43678-024-00761-w
Benjamin Gompels, Luke McCarron, Luka Jovanovic, Thomas Molloy, Vazeer Ahmed, Martin Gargan, Mike Barrett
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引用次数: 0
Ready to launch: a cross-sectional study of field trauma triage and air-ambulance policies across Canada. 蓄势待发:对加拿大各地现场创伤分流和空中救护政策的横断面研究。
IF 2.4 Pub Date : 2024-11-01 Epub Date: 2024-09-30 DOI: 10.1007/s43678-024-00779-0
Kwasi Nkansah-Junior, Rawaan S Elsawi, Ian R Drennan, Melissa McGowan, Brodie Nolan

Purpose: This study aimed to understand current prehospital trauma air-ambulance policies and triage guidelines across Canada. The research question centered on understanding the guidelines used by provinces and territories and identifying potential regional variations in air-ambulance triage.

Methods: We conducted a cross-sectional survey from November 2022 to May 2023, involving trauma leaders from Canada's 13 provinces and territories. Participants were identified via the Trauma Association of Canada and professional networks. The survey, developed with expert input and pilot tested for clarity, focused on prehospital trauma-triage guidelines, level of adoption of Center for Disease Control and Prevention (CDC) triage guidelines, and auto-launch air-ambulance policies. Data were collected using an 18-item electronic survey. Potential response bias was considered, and confidentiality was maintained. A cross-sectional qualitative analysis was used to evaluate the guidelines' adoption and variations, with responses compared across regions.

Results: The analysis revealed a nationwide adoption (11 of 11 respondents) of the CDC guidelines, indicating a standardized approach to patient transportation. Notably, many provinces and territories (5 of 11) endorse auto-launch protocols for air ambulances in specific scenarios. These policies offer advantages in geographically vast regions weighed against the cost of over-triage and inefficient resource allocation. Each province and territory tailors its approach based on factors such as geographic areas served, and available resources.

Conclusion: This study provides a snapshot of the current state of prehospital trauma-triage guidelines in Canada. With some differences in nomenclature, Canadian provinces and territories widely apply the CDC guidelines to serve their populations. There is some regional variation on how transport is initiated within their borders. The findings underscore the delicate balance required for optimizing air-ambulance policies, considering factors such as timely access, resource allocation, and the local application of guidelines.

目的:本研究旨在了解加拿大各地现行的院前创伤空中救护政策和分流指南。研究问题的核心是了解各省和地区使用的指南,并确定空中救护分流方面可能存在的地区差异:我们在 2022 年 11 月至 2023 年 5 月期间进行了一项横向调查,涉及加拿大 13 个省和地区的创伤领导者。参与者是通过加拿大创伤协会和专业网络确定的。调查内容主要涉及院前创伤分诊指南、采用疾病控制和预防中心(CDC)分诊指南的程度以及自动启动空中救护政策。数据收集采用了 18 项电子调查。调查中考虑了可能存在的回答偏差,并对数据进行了保密。采用横断面定性分析来评估指南的采用和变化情况,并对不同地区的答复进行比较:分析结果显示,全国范围内均采用了疾病预防控制中心指南(11 个受访者中有 11 个采用了该指南),这表明患者转运采用了标准化方法。值得注意的是,许多省和地区(11 个受访者中的 5 个)都赞同在特定情况下采用空中救护车自动发射协议。这些政策在地域广阔的地区具有优势,但同时也要权衡过度分流和资源分配效率低下的代价。每个省和地区都会根据所服务的地理区域和可用资源等因素调整其方法:本研究简要介绍了加拿大院前创伤分诊指南的现状。加拿大各省和地区广泛采用疾病预防控制中心的指南为其居民服务,但在术语上存在一些差异。至于在其境内如何启动转运,则存在一些地区差异。研究结果强调了优化空中救护政策所需的微妙平衡,要考虑到及时到达、资源分配和当地应用指南等因素。
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引用次数: 0
This is a call to action for all leaders in Emergency Medicine: men and women. 这是对急诊医学界所有男女领导者的行动号召。
IF 2.4 Pub Date : 2024-11-01 DOI: 10.1007/s43678-024-00794-1
Lauren Lacroix, Lisa Calder
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引用次数: 0
Effectiveness of caregiver educational materials for paediatric community-acquired pneumonia in the emergency department: a qualitative study. 急诊科儿科社区获得性肺炎护理人员教育材料的有效性:一项定性研究。
IF 2.4 Pub Date : 2024-11-01 Epub Date: 2024-10-03 DOI: 10.1007/s43678-024-00777-2
Lara Murphy, Nelson Huang, Sujane Kandasamy, Gita Wahi, Jeffrey M Pernica

Objectives: The objective of this study was to better understand caregiver perspectives on educational materials relating to paediatric community-acquired pneumonia and antibiotic stewardship in the emergency department setting.

Methods: This was a phenomenologically informed qualitative study. Caregivers of young children in Hamilton, Ontario were presented with four educational materials (animated video, physician led lecture-style video, caregiver led testimony-style video, and a printed brochure) providing information relating to treatment strategies for community-acquired pneumonia. Caregivers were then asked open-ended questions about how they felt about the effectiveness of the media used. The principles of conventional content analysis guided the coding and synthesis of the transcribed interviews.

Results: Eleven caregivers were interviewed. Most caregivers preferred the animated video and brochure to the lecture-style physician video and caregiver testimonial video. Common themes for effective educational materials included visually attention-grabbing graphics, accessible language, and formats they could reference following their visit (e.g. brochure).

Conclusions: The busy nature of the emergency department setting can impede effective communication between clinicians and parents. Employing educational materials may allow for more informed parent-provider communication on care decision making. Caregivers in our study prioritized the simplest information formats for education around community-acquired pneumonia and antimicrobial stewardship which could be referenced following discharge. This was best accomplished by short, animated videos and brochures. Results from this study can inform development of future educational materials used in paediatric emergency department settings to optimize caregiver education and corresponding care plan adherence.

研究目的本研究旨在更好地了解护理人员对急诊科环境中与儿科社区获得性肺炎和抗生素管理相关的教育材料的看法:这是一项基于现象学的定性研究。研究人员向安大略省汉密尔顿市的幼儿看护者展示了四种教育材料(动画视频、医生主导的演讲式视频、看护者主导的证词式视频和印刷小册子),这些材料提供了与社区获得性肺炎治疗策略相关的信息。然后向护理人员提出开放式问题,询问他们对所使用媒体的有效性有何看法。在传统内容分析原则的指导下,对转录的访谈内容进行编码和综合:共采访了 11 位护理人员。大多数护理人员更喜欢动画视频和小册子,而不是演讲式的医生视频和护理人员感言视频。有效教育材料的共同主题包括吸引视觉注意力的图片、易懂的语言以及就诊后可参考的格式(如小册子):结论:急诊科环境的繁忙会阻碍临床医生与家长之间的有效沟通。采用教育材料可使家长与医疗服务提供者就护理决策进行更明智的沟通。在我们的研究中,护理人员优先考虑采用最简单的信息形式,围绕社区获得性肺炎和抗菌药物管理进行教育,以便在出院后参考。简短的动画视频和小册子是实现这一目标的最佳方式。这项研究的结果可为今后儿科急诊室教育材料的开发提供参考,从而优化护理人员的教育和相应护理计划的执行。
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引用次数: 0
High-sensitivity troponin assays have the potential to create important improvements in patient care. 高灵敏度肌钙蛋白检测有可能为患者护理带来重大改进。
IF 2.4 Pub Date : 2024-11-01 DOI: 10.1007/s43678-024-00810-4
Martin P Than, W Frank Peacock, Chad M Cannon
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引用次数: 0
Retained gallstone found in a remnant gallbladder post-laparoscopic cholecystectomy using point of care ultrasound. 腹腔镜胆囊切除术后,利用护理点超声检查在残余胆囊中发现残留胆石。
IF 2.4 Pub Date : 2024-11-01 Epub Date: 2024-10-01 DOI: 10.1007/s43678-024-00791-4
Mostafa Alhabboubi, Atif Jastaniah, Joel Turner
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引用次数: 0
Just the facts: how do I manage a teenager with a new eating disorder? 就事论事:如何管理患有新饮食失调症的青少年?
IF 2.4 Pub Date : 2024-11-01 Epub Date: 2024-07-01 DOI: 10.1007/s43678-024-00728-x
Allison Rodrigues, Rosheen Grady, Gregory Harvey
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引用次数: 0
The use of vasopressors to reduce post-intubation hypotension in critically ill adult patients undergoing emergent endotracheal intubation: a scoping review. 使用血管加压素降低接受紧急气管插管的重症成年患者插管后的低血压:范围界定综述。
IF 2.4 Pub Date : 2024-11-01 Epub Date: 2024-08-27 DOI: 10.1007/s43678-024-00764-7
Patricia L G Marks, Jakob M Domm, Laura Miller, Zoey Yao, James Gould, Osama Loubani

Introduction: Patients requiring emergent endotracheal intubation are at higher risk of post-intubation hypotension due to altered physiology in critical illness. Post-intubation hypotension increases mortality and hospital length of stay, however, the impact of vasopressors on its incidence and outcomes is not known. This scoping review identified studies reporting hemodynamic data in patients undergoing emergent intubation to provide a literature overview on post-intubation hypotension in cohorts that did and did not receive vasopressors.

Methods: A systematic search of CINAHL, Cochrane, EMBASE and PubMed-Medline was performed from database inception until September 28, 2023. Two independent reviewers completed the title and abstract screen, full text review and data extraction per PRISMA guidelines. Studies including patients < 18 years or intubations during cardiac arrest were excluded. Primary outcome was the presence of hypotension within 30 min of emergent intubation. Secondary outcomes included mortality at 1 h and in-hospital.

Results: The systematic search yielded 13,126 articles, with 61 selected for final inclusion. There were 24,547 patients with a mean age of 57.2 years and a slight male predominance (63.8%). Respiratory failure was the most common intubation indication. Across 18 studies reporting on vasopressor use prior to intubation, 1171/7085 patients received vasopressors pre-intubation. Post-intubation hypotension occurred in 22.2% of patients across all studies, and in 34.3% of patients in studies where vasopressor administration pre-intubation was specifically reported. One-hour mortality of patients across all studies and within the vasopressor use studies was 1.2% and 1.6%, respectively. In-hospital mortality across studies was 21.5%, and 13.1% in studies which reported on vasopressor use pre-intubation.

Conclusion: Patients requiring emergent intubation have a high rate of post-intubation hypotension and in-hospital mortality. While there is an intuitive rationale for the use of vasopressors during emergent intubation, current evidence is limited to support a definitive change in clinical practice at this time.

导言:由于危重病人的生理机能发生改变,需要紧急气管插管的病人发生插管后低血压的风险较高。插管后低血压会增加死亡率和住院时间,但血管加压剂对其发生率和结果的影响尚不清楚。本范围界定性综述确定了报告紧急插管患者血液动力学数据的研究,以提供关于插管后低血压的文献概览,包括接受和未接受血管加压剂的组群:方法:对 CINAHL、Cochrane、EMBASE 和 PubMed-Medline 进行了系统检索,检索期从数据库开始至 2023 年 9 月 28 日。两名独立审稿人根据 PRISMA 指南完成了标题和摘要筛选、全文审阅和数据提取。包括患者在内的研究结果:系统性检索共获得 13,126 篇文章,最终筛选出 61 篇纳入研究。共有 24,547 名患者,平均年龄为 57.2 岁,男性略占多数(63.8%)。呼吸衰竭是最常见的插管适应症。18 项研究报告了插管前使用血管加压素的情况,其中 1171/7085 例患者在插管前使用了血管加压素。在所有研究中,22.2%的患者在插管后出现低血压,而在特别报告插管前使用血管加压剂的研究中,34.3%的患者在插管后出现低血压。在所有研究和使用血管加压素的研究中,患者一小时死亡率分别为1.2%和1.6%。所有研究的院内死亡率为21.5%,在报告插管前使用血管加压素的研究中,院内死亡率为13.1%:结论:需要紧急插管的患者插管后低血压和院内死亡率较高。虽然在紧急插管期间使用血管加压素有其直观的理由,但目前的证据有限,不足以支持在临床实践中做出明确的改变。
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引用次数: 0
An overview of vasopressors for post-intubation hypotension in critically ill adult patients: the lay of the land. 针对成人重症患者插管后低血压的血管加压剂概述:应用领域。
IF 2.4 Pub Date : 2024-11-01 DOI: 10.1007/s43678-024-00801-5
Abel Wakai, Ariel Hendin
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引用次数: 0
Effect of bougie use on first-attempt success in tracheal intubations: a systematic review and meta-analysis. 使用通气导管对气管插管首次尝试成功率的影响:系统回顾和荟萃分析。
IF 2.4 Pub Date : 2024-11-01 Epub Date: 2024-11-06 DOI: 10.1007/s43678-024-00805-1
Samuel J Wilson, Ariel Hendin, Venkatesh Thiruganasambandamoorthy
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引用次数: 0
期刊
CJEM
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