Primary Survey
Pain control is a key element in the management of patients, enshrined in the UN rights of the child.
See pages 838 and 887
A ground breaking survey of the use of pain relief is presented by Loryman et al, with disappointing results; this paper will act as an important benchmark, against which departments measure their performance. The need for continuing education is highlighted in this area by a survey of SHOs knowledge and prescribing of pain relief in paediatric patients, conducted by Brennan, Beattie and Kind.
Aggressive goal orientated treatment protocols for severe sepsis has shown to reduce mortality by 16% in the US. The applicability of the surviving sepsis campaign guidelines to the UK setting is reviewed and the authors suggest that they should be followed in our emergency departments.
See page 828
Intravascular coagulaopathy is commonly encountered after large volume resuscitation. The study of in vivo adminstration of normal saline and Gelofusine fluids to healthy volunteers show important effects not picked up by conventional assessment of coagulation.
See page 846
This postal questionnaire sent to patients managed by emergency care practitioners, between October and December 2004, showed that compared with care delivered by traditional ambulance practitioners, thoroughness of assessment and explaining what happened next scored more highly (out of 13 research based items put to the 1658 patients, 888 of whom responded). Communication may be the key thing.
See page 865
Physiological scoring system, MEWS and assessment score for sick patient identification and step up treatment score may not add little in determining sick patients in the emergency department.
See page 841
Think before you make it worse! A practical guide to the thinking about your own safety at the scene of an incident.
See page 878
Eager and Banks suggest that rotating foundation year 2 posts every 4 months will not affect the workload of an emergency department in that a similar number of patients are seen over the year.
See page 888
A London based study showed the educational performances of emergency medical technicians (EMT) training to be emergency care practitioners (ECP) to be similar to those from paramedic matched individuals. The EMT-ECPs seems to have higher ‘treat and leave rates’. The authors point out that the differences in performances of ECPs may be influenced by their background, and that as long as the professional registration in the educational and clinical govermance is robust, the ECP role for EMTs and others is open.
See page 888
This study in Australia sets up benchmarks for audits in this area — it seems that that things are getting better as the reported adverse events are lower than in previous studies.
See page 858
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