1421 The Scottish Code Red Audit report for the period 1st January 2018 to 31st December 2019 with comparison to previous audit findings of Scottish Code Red practice since 1 June 2013
Conclusion
There were 96 Code Red activations. Mean age was 43 (SD 18) years, and 66 (69%) were male. Median ISS was 29 (IQR 19–41, n=76, mean ISS 31, SD 17) with 71 (74%) blunt trauma. 87 (90%) received blood components with 73 (76%) receiving pre-hospital transfusion. 67 of 73 (92%) who received pre-hospital transfusion, received further hospital transfusion. Median time from 999 call to Code Red activation was 80 (IQR 56–106, n=47) minutes and 77 (93%, n=93) patients received pre-hospital TXA. Median time after ED arrival to transfusion was 4 minutes (IQR 0–17, n=50) for Concentrated Red Cells (CRC) an...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Reed, M., On behalf of the Scottish Transfusion and Laboratory Support in Trauma Group Matthew J Reed Hamish McLay Neil Hughes Niall McMahon Nicola Littlewood Katherine Hands Jennifer Laird Margaret McGarvey April Molloy Claire Mckie Arran Keir Patrick He Tags: RCEM Moderated Papers Source Type: research
1412 Cervical spine immobilisation in ambulatory patients
Conclusion
Cervical spine fracture was diagnosed in 30 patients each year on average over the study period. Fifteen per cent were not conveyed by ambulance. Over 70% of patients presented more than 4 hours after their injury. The most common site of injury was C6/7 (50%) followed by C2 (30%). Those patients who self-presented to the emergency department and were subsequently diagnosed with a cervical spine fracture suffered no adverse outcomes. Self-presentation to the emergency (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Phillips, H., Savadia, K., Johnson, G. Tags: RCEM Moderated Papers Source Type: research
1632 Clinical predictors of fracture in patients with shoulder dislocation: systematic review of diagnostic test accuracy studies
Conclusion
Eight studies reported data on 2,087 shoulder dislocations and 343 concomitant fractures. The prevalence of concomitant fracture was 17.5%. The most accurate clinical predictors were age >40 (LR+ 1.8 [95% CI 1.5–2.1]; LR- 0.4 [0.2–0.6]), female sex (LR+ 2.0 [1.6–2.4], LR- 0.7 [0.6–0.8]), first time dislocation (LR+ 1.7 [1.4–2.0]; LR-0.2 [0.1–0.5]), and presence of humeral ecchymosis (LR+ 3.0–5.7; LR- 0.8–1.1). The most important mechanisms of injury were: high-energy mechanism fall (LR+ 2.0–9.8), fall >1 flight of stairs (LR+ 3.8 [95% CI 0.6–13.1]...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Oldrini, I., Coventry, L., Novak, A., Gwilym, S., Metcalfe, D. Tags: RCEM Moderated Papers Source Type: research
1455 A 10-year review of insulin-related enquiries to the UK National Poisons Information Service (NPIS)
Conclusion
We received 1195 enquiries involving insulin. Further analysis was limited to the 169 enquiries involving insulin only (90.5% via injection).
Most enquiries (88%) concerned adults ≥ 18 years. There were 34 non-diabetic and 98 diabetic patients: 32 Type 1, 10 Type 2, and 56 type undocumented. Exposures were intentional (n=114, 68%), from therapeutic error (n=28), accidental (n=16) or circumstances unknown (n=11).
Long-acting insulins were involved in 71 cases, and the highest dose was 20000 units (table 1). The lowest recorded blood glucose concentration (mmol/L) at the time of the enquiry was in the range 0&n...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Moyns, E., Ferner, R., Euan, S., Gray, L., Thanacoody, R., Bradberry, S. Tags: RCEM Moderated Papers Source Type: research
1718 Another CT aortogram request? A 1 year retrospective case note review of all ED-requested CT aortograms
Conclusion
201 CTA were requested by ED in a single year (2019).
5 (2.4%) scans diagnosed acute aortic syndrome (AAS), with an additional 3 scans that identified thoracic aortic aneurysm without AAS.
13 (6.5%) abdominal aortic aneurysms were identified of which 2 had ruptured.
In addition, 24 (11.9%) patients had non aortic pathologies identified from the scan (6 gallstones, 3 pneumonia, 3 renal colic, 2 metastatic disease, 2 pancreatitis, 2 pulmonary embolism, 6 ‘other’ diagnoses).
Of those with confirmed AAS, only one had an ADD-RS (aortic dissection detection risk score) of 2 (>2 recommend straight to CTA...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Manouchehri, S., Wilson, S., Ticehurst, F. Tags: RCEM Moderated Papers Source Type: research
