Effectiveness of innovative chest compression on the emergency department stretcher by an alternative method: a randomized controlled crossover trial.

Comparison of the three methods standing-on-a-stool (SS), one knee kneeling on a stretcher (KS), and kneeling at the same height as the patient's bed on the kneeling stool (KK) to evaluate the yielded of highest CPR quality and rescuer comfortability. A prospective randomized cross-over study which compares the three different rescuer positions for their effectiveness of chest compression. Conducted at a tertiary care between 19 and 22 Aug 2022. Emergency personnel aged 18 years or older, who completed the AHA-approved BLS course. The chest compression data was obtained by the ALIVE AED manikin® and AED reporting system. The information on the CPR quality and post-test questionnaires assessing the participants' preference, satisfaction and modified Borg's scale score was collected. The three methods shown no statistically significant difference in adequate chest compression depth (percentage). KK was not superior than SS at chest compression rate (P = 0.05). The adequate full chest recoil achieved with KK and KS were significantly higher than that of SS. However, there were no statistical difference between the three methods in the modified Borg's scale score. Based on the satisfying score, the rescuers preferred KK to either SS (p 0.007) or KS (p 0.012). The three methods shown no statistically significant difference in adequate chest compression depth (percentage). Still, both KK and KS provided more adequate chest recoil, so we would recommend using these two methods in the ED.Clinical trial registry: This study was retrospective registration in thaiclinicaltrials.org (TCTR20230119002, 19/1/2023).

Quality of gout care in the emergency departments: a multicentre study.

BACKGROUND: To report on prevalence of gout flare in emergency departments and to report the quality of gout care in emergency departments and causes of admission at emergency departments. METHODS: A retrospective chart review of visits that had a primary diagnosis in gout by the International Classification of Diseases, the tenth revision, at emergency departments from 6 universities in Thailand over a 5 year period from 1 January 2012 to 31 December 2016. RESULTS: Six hundred thirty-two visits were included to the study. Prevalence of gout flare in emergency departments was 0.04. Only 29.3% of the visits had arthrocentesis. 628/632 (99.4%) and 519/585 (88.7%) of the visits were prescribed medications in emergency departments and had home medications, respectively. Although all visits that were prescribed colchicine in emergency departments received adequate doses of colchicine, it was also found that more than 2.4 mg/day of colchicine was prescribed (3/394, 0.8%) for home medications. In addition, 183/343 (53.4%) of the visits with normal renal function were prescribed non-steroidal anti-inflammatory drugs (NSAIDs). However, prescribed NSAIDs in abnormal renal function (42/343, 12.2%) was also found. The interruption of dosing, including increase, decrease, addition or discontinuance of urate lowing therapy in a gout flare period was 42/632 (6.6%). The most common cause of admission was acute gouty arthritis (31/47, 66.0%). CONCLUSIONS: Quality of gout care in the emergency departments was not good. Inappropriate management of gout flare in emergency departments was demonstrated in our study, particularly with regard to investigations and pharmacological management. Gaps between clinicians and guidelines, the knowledge of clinicians, and overcrowding in emergency departments were hypothesized in the results.