The RAMA Ped Card: Does it work for actual weight estimation in child patients at the emergency department

BACKGROUND: In emergency conditions, the actual weight of infants and young children are essential for treatments. The RAMATHIBODI Pediatric Emergency Drug Card or RAMA Ped Card has also been developed to estimate actual weight of the subjects. This study aimed to validate the RAMA Ped Card in correctly identifying the actual weight of infants and young adults.     

Stroke Fast Track Reduces Time Delay to Neuroimaging and Increases Use of Thrombolysis in an Academic Medical Center in Thailand

Delays between hospital arrival and neuroimaging prevented patients from receiving thrombolysis. We report impact of Stroke Fast Track (SFT) on time to imaging, and rates of recombinant tissue plasminogen activator (rt‐PA) in eligible patients. Characteristics, time intervals, and rates of rt‐PA were evaluated in 464 patients with suspected acute stroke within 7 days (2005–2006). Complete time intervals were available on 380. Median times between emergency room arrival, brain computerized tomography (CT), and CT results were 25 and 45 minutes, respectively, for patients arriving <3 hours from onset, 40, and 65 minutes for those arriving >3 hours, and 35 and 60 minutes for all patients, which is significantly shorter than 2.5 hours to CT in 2004, prior to SFT (P < .0001). Although not different in time to first physician, patients arriving >3 hours had longer times to CT and CT results (P < .001). Overall, 5.5% of ischemic stroke patients received intravenous rt‐PA, including 27.1% of those arriving within 3 hours, which represented 100% of all eligible patients, compared with 0% in 2004. SFT reduced time delay in neuroimaging and increased use of rt‐PA in Thailand. Continuous quality improvement is needed to achieve best results in each setting, and to insure optimal care for acute stroke patients.     

Effects of prehospital adrenaline administration on out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis

Introduction

The aim of this study was to conduct a systematic review and meta-analysis for determining the effects of prehospital adrenaline administration on return of spontaneous circulation, hospital admission, survival to discharge and discharge with cerebral performance category 1 or 2 in out-of-hospital cardiac arrest patients.

Methods

MEDLINE and Scopus databases were searched to identify studies reported to March 2014. Study selection and data extraction were independently completed by two reviewers (PA and SR). The baseline characteristics of each study and number of events were extracted. Risk ratios (RR) and 95% confidence interval (CI) were estimated. Heterogeneity and publication bias were also explored.

Results

In total 15 studies were eligible and included in the study. Of 13 adult observational studies, four to eight studies were pooled for each outcome. These yielded a total sample size that ranged from 2,381 to 421,459. A random effects model suggested that patients receiving prehospital adrenaline were 2.89 times (95% CI: 2.36, 3.54) more likely to achieve prehospital return of spontaneous circulation than those not administered adrenaline. However, there were no significant effects on overall return of spontaneous circulation (RR = 0.93, 95% CI: 0.5, 1.74), admission (RR = 1.05, 95% CI: 0.80, 1.38) and survival to discharge (RR = 0.69, 95% CI: 0.48, 1.00).

Conclusions

Prehospital adrenaline administration may increase prehospital return of spontaneous circulation, but it does not improve overall rates of return of spontaneous circulation, hospital admission and survival to discharge.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-014-0463-7) contains supplementary material, which is available to authorized users.     

Analysis of trends in emergency department attendances, hospital admissions and medical staffing in a Hong Kong university hospital: 5-year study

Background

The workload of emergency departments (ED) continually changes in response to presentations, overcrowding and availability of expertise and investigations.

Aims

To investigate changes in ED presentations and care processes, and the relationship of patient demand and ED staff resources to waiting times and processing times.

Methods

Retrospective analysis of prospectively collected administrative data from January 1999 to April 2005 in an emergency department in a university teaching hospital in Hong Kong. All patients attending the emergency department during the study period were included. Monthly attendance data were retrieved and analysed to determine both qualitative and quantitative changes in the patterns of presentation to the ED using prospectively gathered data.

Results

Total ED attendances decreased by 25% during the study with little seasonal variation. The admission rate and the use of ambulances increased steadily and significantly. Medical patients are increasing proportionately, but trauma patients are decreased in number.

Conclusion

There have been major changes in the patterns of ED attendances and ED waiting times over the study period in this teaching hospital ED. Decreasing overall ED numbers are offset by an increasingly elderly population and a more complex case mix. Reducing clinical staff numbers appears to reduce the ED’s capacity to provide timely assessments and care and to function as hospital gatekeepers. Restoring staff numbers to previous levels may improve the quality and timeliness of ED services. It is necessary to refine measures of ED complexity and workload to determine appropriate staffing levels in the future.