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To address this, a combination of effective preoperative education, individualised communication and involvement of social support should be considered.<br /><br /> Preoperative concerns can negatively impact patients and effective interventions will result in a better perioperative experience with fewer negative consequences arising from patients' fear and anxiety.<br /><br />Preoperative concerns can negatively impact patients and effective interventions will result in a better perioperative experience with fewer negative consequences arising from patients' fear and anxiety.<br /><br /> As a part of an evaluation of a large-scale communication skills training (CST) programme, this study aimed to investigate the effect on health care professionals' (HCPs) self-efficacy (SE) and perceived importance (PI) of the skills taught.<br /><br /> A pre-post intervention design was used, and 1647 HCPs responded to the SE-12 questionnaire. Changes in self-efficacy were examined at an item and scale level.<br /><br /> The responses of 74% of the HCPs who replied to at least two of the three questionnaires were analysed. A significant increase in the SE-12 scale scores by 12.45 points between Q1 (baseline) and Q2 (immediately after the intervention) across all professions was found. There was a small albeit statistically significant decrease in the SE-12 scale scores by 2.06 points between Q2 and Q3 (24 weeks after the intervention).<br /><br /> The implementation of the CST course significantly improved the self-efficacy of HCPs. The findings were supported by an increase in the number of HCPs who considered the skills that they had acquired to be very important.<br /><br /> The findings suggest that the large-scale implementation of evidence-based CST programmes can yield the same outcomes that have been observed in smaller and better controlled studies.<br /><br />The findings suggest that the large-scale implementation of evidence-based CST programmes can yield the same outcomes that have been observed in smaller and better controlled studies.<br /><br /> The aim of this study was to determine the effects of manual lancets and automatic lancets on neonatal capillary heel blood sampling pain.<br /><br /> This was a parallel-group, prospective, randomized controlled and observational trial. Participants were randomly assigned (11) to the manual lancet (odd days of the month) and automatic lancet groups (even days of the month) for capillary heel blood sampling. The sample consisted of 60 term neonates divided into two groups Manual lancet (n=30) and automatic lancet (n=30). Heart rate, oxygen saturation, duration of blood collection, presence of crying, number of heel punctures, possible complications and pain were measured.<br /><br /> The manual lancet group had significantly lower oxygen saturation (P=.000), higher mean heart rate (P=.008), more crying neonates (P=.000), higher number of punctures for blood sampling (P=.000) and longer mean duration of blood collection (P=.000) than the automatic lancet group. While there was no difference in the prevalence of elevated temperature, stiffness and edema between the two groups, the automatic lancet group had less redness (P=.028), bruising (P=.000) and a significantly lower mean Neonatal Infant Pain Score than the manual lancet group (P=.000).<br /><br /> Use of automatic lancets for heel blood sampling helps reduce pain in neonates which is of critical importance.<br /><br /> Use of automatic lancets for heel blood sampling helps reduce pain in neonates. Therefore, neonatal nurses should routinely use automatic lancets in clinical settings to cause less pain in neonates.<br /><br />Use of automatic lancets for heel blood sampling helps reduce pain in neonates. Therefore, neonatal nurses should routinely use automatic lancets in clinical settings to cause less pain in neonates.<br /><br /> Life-threatening hemorrhage from extremity injuries can be effectively controlled in the prehospital environment through direct pressure, wound packing, and the use of tourniquets. Early tourniquet application has been prioritized for rapid control of severe extremity hemorrhage and is a cornerstone of prehospital trauma resuscitation guidelines. Emergency physicians must be knowledgeable regarding the initial assessment and appropriate management of patients who present with a prehospital tourniquet in place.<br /><br /> An interdisciplinary group of experts including emergency physicians, trauma surgeons, and tactical and Emergency Medical Services physicians collaborated to develop a stepwise approach to the assessment and removal (discontinuation) of an extremity tourniquet in the emergency department after being placed in the prehospital setting. We have developed a best-practices guideline to serve as a resource to aid the emergency physician in how to safely remove a tourniquet. The guideline contains five steps that include 1) Determine how long the tourniquet has been in place; 2) Evaluate for contraindications to tourniquet removal; 3) Prepare for tourniquet removal; 4) Release the tourniquet; and 5) Monitor and reassess the patient.<br /><br /> These steps outlined will help emergency medicine clinicians appropriately evaluate and manage patients presenting with tourniquets in place. Tourniquet removal should be performed in a systematic manner with plans in place to immediately address complications.<br /><br />These steps outlined will help emergency medicine clinicians appropriately evaluate and manage patients presenting with tourniquets in place. Tourniquet removal should be performed in a systematic manner with plans in place to immediately address complications.<br /><br /> Some admitting physicians request a medication-free interval ("spacing trial") in the emergency department (ED) to determine whether a patient with an acute exacerbation of asthma can be safely admitted to a hospital ward bed, where bronchodilators are only available every 4h.<br /><br /> Our objectives were to estimate the frequency of ED spacing trials in different hospitals and their associated time cost.<br /><br /> This multicenter retrospective cohort study examined patients admitted for asthma from 2015 to 2018. We included all university records and a random sample of records from two community hospitals in the same urban area. Two team members abstracted data from each record using recommended methods, with group consensus to resolve differences. Proportion confidence intervals were calculated using normal binomial approximation. We calculated mean differences in ED stay associated with spacing trials, using multivariable linear regression to adjust for age, hospital type, history of intubation, initial pulse, initial respiratory rate, initial signs of distress.<br /><br /> We collected data from 274 patients in the university hospital, and 71 and 70 cases from the community hospitals. An explicit spacing trial was noted in 52 of 274 (19%) university hospital records vs. 3 of 141 (2%) community hospital records, with a difference of 17% (95% confidence interval [CI] 11-23%). Delayed patient decompensation occurred in 3%, with no difference between hospitals. Spacing trials were associated with an adjusted mean of 159min (95% CI 102-217min) increase in ED stay.<br /><br /> The practice of spacing varies widely between hospitals and is associated with substantial delay without an apparent benefit.<br /><br />The practice of spacing varies widely between hospitals and is associated with substantial delay without an apparent benefit.<br /><br /> Orbital compartment syndrome (OCS) is an ocular emergency that can severely threaten the visual potential. The most common etiologies include facial trauma-related orbital wall fractures and postoperative bleeding within the orbit. Nontraumatic cases were also reported sporadically, although they are rare. The orbital volume limits the compliance to expand when space-occupying lesions develop. Both direct compression of the optic nerve and depleted perfusion from elevated intraorbital pressure subsequently lead to ischemic optic neuropathy and vision loss.<br /><br /> A 74-year-old man experienced headache, bulging left eye, dull pain, vision loss, nausea, and vomiting within 1day. Computed tomography and magnetic resonance imaging revealed a heterogeneous mass extending from the orbital apex and connected with the ophthalmic vein. Lateral canthotomy and cantholysis were performed at bedside for emergent orbital decompression. The proptosis and pain relieved after surgery, but visual loss remained irreversible. Surgi? Clinicians should be aware of the presentation of OCS and perform timely orbital decompression, which could reverse visual impairment. These patients might also benefit from immediate consultants with ophthalmologists and radiologists.<br /><br /> Phlegmonous gastritis (PG) is a rare and potentially fatal disease characterized by bacterial infection of the gastric wall. However, its clinical features are nonspecific, which may delay its diagnosis and treatment.<br /><br /> We report a case of a previously healthy 53-year-old woman with localized PG complicated by subphrenic abscess formation who was treated successfully with antibiotics and percutaneous catheter drainage. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? Early diagnosis and treatment initiation are important to improving outcomes. Emergency physicians should consider PG a differential diagnosis of acute abdomen.<br /><br />We report a case of a previously healthy 53-year-old woman with localized PG complicated by subphrenic abscess formation who was treated successfully with antibiotics and percutaneous catheter drainage. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? Early diagnosis and treatment initiation are important to improving outcomes. Emergency physicians should consider PG a differential diagnosis of acute abdomen.<br /><br /> Personal protective equipment (PPE) is equipment that protects health care workers from harmful agents and organisms. The importance of this equipment was noticed again with the Coronavirus Disease 2019 (COVID-19) pandemic.<br /><br /> In this study, we investigated the effect of different masks used as PPE on resuscitation quality and rescuer fatigue.<br /><br /> Participants applied chest compression without a mask, with a surgical mask, a filtering face-piece respirator (FFR) mask, and a half-face mask with active P3 filter. A smart watch was worn on the left wrists of the participants during chest compression in each condition. [https://www.selleckchem.com/products/bay-2402234.html selleck chemicals] They were requested to rate their fatigue on a visual analogue scale.<br /><br /> Statistically higher average pulse rates were found in the FFR mask and half-face mask conditions. FFR mask and half-face mask resulted in statistically worse results than surgical mask and no-mask conditions in the number of compressions per minute, compression depth, and compression effectiveness. Further, half-face mask and FFR mask caused more fatigue in participants.<br /><br /> Protective masks other than surgical masks used as PPE increase rescuer fatigue in CPR and negatively affect the quality of chest compressions.<br /><br />Protective masks other than surgical masks used as PPE increase rescuer fatigue in CPR and negatively affect the quality of chest compressions.<br /><br /> Snake bite is a grossly underreported public health issue in subtropical, tropical suburban, and rural areas of Africa and South Asia. In literature, ophitoxemia (snake bite envenomation) as a cause of acute coronary syndrome (ACS) is limited to very few case reports. Viper envenomation is the most common cause of ACS among snake bites. We report the first case of unstable angina caused by Colubridae snake bite (Ahaetullanasuta, commonly called green snakes) in a young man without comorbidities.<br /><br /> A young healthy man had a green snake bite that was camouflaged in the green fodder. He was managed elsewhere with anti-snake serum. He developed acute chest pain and breathlessness on day 3 of his treatment. Electrocardiogram (ECG) showed biphasic T wave inversions suggestive of type A Wellens pattern in the anterior chest leads (V1-V4). He was treated for ACS medically outside and was referred to our institute for further management on the following day. ECG and cardiac enzymes were normal. The echocardiogram showed no regional wall motion abnormality.