Browsing by Subject "Emergency care"

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  • Sturesson, L.; Lindstrom, V.; Castren, M.; Niemi-Murola, L.; Falk, A. -C. (2016)
    Background: Pain is one of the most common symptoms in the Emergency Department (ED) and is the cause of more than half of the visits to the ED. Several attempts to improve pain management have been done by using, for example, standards/guidelines and education. To our knowledge no one has investigated if and how different actions over a longitudinal period affect the frequency of pain documentation in the ED. Therefore the aim of this study was to describe the frequency of documented pain assessments in the ED. Method: A cross-sectional study during 2006-2012 was conducted. The care of patients with wrist/arm fractures or soft tissue injuries on upper extremities was evaluated. Result: Despite various actions our result shows that mandatory pain assessment in the patient's computerized medical record was the only successful intervention to improve the frequencies of documentation of pain assessment during care in the ED. During the study period, no documentation of reassessment of pain was found despite the fact that all patients received pain medication. Conclusion: To succeed in increasing the frequency of documented pain assessment, mandatory pain rating is a successful action. However, the re-evaluation of documented pain assessment was nonexisting. (C) 2016 Elsevier Ltd. All rights reserved.
  • EMS-AHF Study Grp; Harjola, Pia; Miro, Oscar; Martin-Sanchez, Francisco J.; Kuisma, Markku; Tarvasmäki, Tuukka; Harjola, Veli-Pekka; Hoppu, Sanna; Iirola, Timo; Kurola, Jouni; Lund, Vesa; Martikainen, Matti; Makela, Pekka; Torronen, Kari; Wilen, Susanna (2020)
    Aim To illustrate the pre-hospital management arsenals and protocols in different EMS units, and to estimate the perceived difficulty of diagnosing suspected acute heart failure (AHF) compared with other common pre-hospital conditions. Methods and results A multinational survey included 104 emergency medical service (EMS) regions from 18 countries. Diagnostic and therapeutic arsenals related to AHF management were reported for each type of EMS unit. The prevalence and contents of management protocols for common medical conditions treated pre-hospitally was collected. The perceived difficulty of diagnosing AHF and other medical conditions by emergency medical dispatchers and EMS personnel was interrogated. Ultrasound devices and point-of-care testing were available in advanced life support and helicopter EMS units in fewer than 25% of EMS regions. AHF protocols were present in 80.8% of regions. Protocols for ST-elevation myocardial infarction, chest pain, and dyspnoea were present in 95.2, 80.8, and 76.0% of EMS regions, respectively. Protocolized diagnostic actions for AHF management included 12-lead electrocardiogram (92.1% of regions), ultrasound examination (16.0%), and point-of-care testings for troponin and BNP (6.0 and 3.5%). Therapeutic actions included supplementary oxygen (93.2%), non-invasive ventilation (80.7%), intravenous furosemide, opiates, nitroglycerine (69.0, 68.6, and 57.0%), and intubation 71.5%. Diagnosing suspected AHF was considered easy to moderate by EMS personnel and moderate to difficult by emergency medical dispatchers (without significant differences between de novo and decompensated heart failure). In both settings, diagnosis of suspected AHF was considered easier than pulmonary embolism and more difficult than ST-elevation myocardial infarction, asthma, and stroke. Conclusions The prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre-hospital conditions.
  • Salo, Taneli (Helsingfors universitet, 2015)
    Problem: As a part of the Finnish Allergy Programme 2008-18, we surveyed patients to assess allergy symptoms, the use of medications and health care services in Finland. Methods: We studied the determinants of moderate-severe allergic rhinitis (AR) (numeric rating scale, NRS 6-10, n=682) and the relationship of NRS and Rhinasthma questionnaire. Use of medication and use of health care services were studied. Results: In the moderate-severe AR group, the most disruptive symptom domains included the nasal, burden and eye domains. Likewise, the need to take medication, nasal congestion and avoiding environments represented the most disruptive individual symptoms. Allergy severity (NRS) correlated best with nasal symptoms (r=0.44, p<0.001) and with eye symptoms (r=0.44, p<0.001). 14.1% reported emergency room treatment. Conclusions: Moderate-severe AR represents a burden among patients. Nasal congestion, need to take medications and avoiding environments are the most common complaints. Moderate-severe AR patients have also emergency care use.