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Open Access Emergency Medicine: OAEM

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https://www.readbyqxmd.com/read/27877069/risk-factors-and-mortality-associated-with-undertriage-at-a-level-i-safety-net-trauma-center-a-retrospective-study
#1
Chris Barsi, Peter Harris, Rich Menaik, Nicholas C Reis, Swapna Munnangi, Mikhail Elfond
PURPOSE: The primary objective of this study was to determine the risk factors associated with undertriage and the risk factors for mortality among the undertriaged patients at a level I safety-net trauma center. METHODS: A retrospective analysis was performed of all trauma patients who presented to a level I safety-net trauma center with an injury severity score >15 over a 2-year period (2013-2014). Univariate and multivariate regression analyses were used to determine the risk factors predictive of undertriage in major trauma patients (injury severity score >15) and of mortality in undertriaged patients...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27843362/isolated-oculomotor-nerve-palsy-resulting-from-acute-traumatic-tentorial-subdural-hematoma
#2
Victoria Cui, Timur Kouliev
Acute subdural hematoma (SDH) resulting from head trauma is a potentially life-threatening condition that requires expedient diagnosis and intervention to ensure optimal patient outcomes. Rapidly expanding or large hematomas, elevated intracranial pressure, and associated complications of brain herniation are associated with high mortality rates and poor recovery of neurological function. However, smaller bleeds (clot thickness <10 mm) or hematomas occurring in infrequent locations, such as the tentorium cerebelli, may be difficult to recognize and patients may present with unusual or subtle signs and symptoms, including isolated cranial nerve palsies...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27843361/pulmonary-embolism-new-treatments-for-an-old-problem
#3
REVIEW
John Ryan
Nonvitamin K antagonist oral anticoagulants, previously referred to as novel oral anticoagulants, have emerged in recent years as attractive treatment options for acute pulmonary embolism (PE). However, despite the widespread anticipation by physicians and the approval of rivaroxaban, apixaban, dabigatran, and more recently edoxaban, there is still some reluctance to choose these newer agents over conventional treatment with heparin/vitamin K antagonists. Acute PE puts a considerable strain on emergency departments, and medical staff rely on efficient diagnosis and risk assessment to manage the condition appropriately and economically...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27822127/objective-triage-in-the-disaster-setting-will-children-and-expecting-mothers-be-treated-like-others
#4
Timur Kouliev
The study of disaster triage is made difficult by the complex emotional response of potentially lifesaving intervention that a triage officer must make basing decisions on a succinct and efficient algorithm. A survey of triage professionals in international settings was designed to identify possible emotionally led bias that affects objective decision making in identifying victims most likely to benefit from immediate life support intervention. This survey suggests a lack of correlation between triage priority and predictable clinical outcomes as predicted by the Revised Trauma Score tool...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27703399/acute-chest-pain-after-bench-press-exercise-in-a-healthy-young-adult
#5
Janet A Smereck, Argyro Papafilippaki, Sawali Sudarshan
Bench press exercise, which involves repetitive lifting of weights to full arm extension while lying supine on a narrow bench, has been associated with complications ranging in acuity from simple pectoral muscle strain, to aortic and coronary artery dissection. A 39-year-old man, physically fit and previously asymptomatic, presented with acute chest pain following bench press exercise. Diagnostic evaluation led to the discovery of critical multivessel coronary occlusive disease, and subsequently, highly elevated levels of lipoprotein (a)...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27660500/clinical-outcomes-of-3-year-experience-of-targeted-temperature-management-in-patients-with-out-of-hospital-cardiac-arrest-at-songklanagarind-hospital-in-southern-thailand-an-analysis-of-the-micu-ttm-registry
#6
Veerapong Vattanavanit, Rungsun Bhurayanontachai
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of intensive care unit admission, which results in high hospital mortality. Targeted temperature management (TTM) was introduced several years ago and is considered to improve neurological and mortality outcomes. This management process was implemented in our hospital in 2012, which was expected to improve the standard of care in OHCA patients. PURPOSE: We aimed to report the clinical and mortality outcomes after TTM was introduced to our hospital in 2012...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27660499/bilateral-acute-closed-angle-glaucoma-associated-with-the-discontinuation-of-escitalopram-a-case-report
#7
Sara AlQuorain, Sukayna Alfaraj, Mohammed Alshahrani
A 45-year-old woman presented to the Emergency Department complaining of severe headache for 3 hours duration associated with bilateral blurred vision, photophobia, and one attack of vomiting. Her clinical examination revealed normal vital signs and decrease in visual acuity with hazy cornea bilaterally. There were no signs of increased intracranial pressure and no neck rigidity or meningeal signs. The patient was diagnosed with bilateral acute closed angle glaucoma (AACG) with intraocular pressure of 60 mmHg in both eyes...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27621675/meperidine-pethidine-versus-morphine-in-acute-pain-management-of-opioid-dependent-patients
#8
Hassan Solhi, Hossein Sanaei-Zadeh, Sadra Solhi, Mohammad Ali Azizi Nadian, Morteza Gharibi, Bahman Sadeghi Sedeh
The present study aimed to evaluate the effectiveness of morphine and meperidine (pethidine) as pain relief in opioid-dependent patients with acute pain. A total of 122 opioid-dependent patients with acute pain were included in the study. Their pain severity was assessed, using visual analog scale (VAS) scores ranging from 0 to 10. The patients randomly received intravenous morphine (up to 0.15 mg/kg) or meperidine (up to 1.5 mg/kg) for pain control by patient control analgesia (PCA) pump. The clinical opioid withdrawal scale (COWS) was employed for the assessment of withdrawal symptoms...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27471415/asthma-related-emergency-department-use-current-perspectives
#9
REVIEW
Laurie H Johnson, Patricia Chambers, Judith W Dexheimer
Asthma is one of the most common chronic pediatric diseases. Patients with asthma often present to the emergency department for treatment for acute exacerbations. These patients may not have a primary care physician or primary care home, and thus are seeking care in the emergency department. Asthma care in the emergency department is multifaceted to treat asthma patients appropriately and provide quality care. National and international guidelines exist to help drive clinical care. Electronic and paper-based tools exist for both physicians and patients to help improve emergency, home, and preventive care...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27307771/cardiopulmonary-laboratory-biomarkers-in-the-evaluation-of-acute-dyspnea
#10
REVIEW
Natalie R Stokes, Brett W Dietz, Jackson J Liang
Dyspnea is a common chief complaint in the emergency department, with over 4 million visits annually in the US. Establishing the correct diagnosis can be challenging, because the subjective sensation of dyspnea can result from a wide array of underlying pathology, including pulmonary, cardiac, neurologic, psychiatric, toxic, and metabolic disorders. Further, the presence of dyspnea is linked with increased mortality in a variety of conditions, and misdiagnosis of the cause of dyspnea leads to poor patient-level outcomes...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27307770/early-recognition-of-intraventricular-hemorrhage-in-the-setting-of-thrombocytosis-in-the-emergency-department
#11
Marvinia Charles, Romy Fontoura, Gregory Sugalski
Thrombocytosis is frequently encountered as an incidental laboratory finding since isolated thrombocytosis is often asymptomatic. Even though thrombocytosis is benign and self-limiting in most cases, it can at times result in thrombosis or hemorrhage. The most common type of thrombocytosis is reactive (secondary) thrombocytosis and can be due to infections, trauma, surgery, or occult malignancy. Since thrombocytosis is a known risk factor for thrombosis, it is commonly a concern for ischemic stroke and myocardial infarction...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27307769/interventions-to-reduce-the-risk-of-violence-toward-emergency-department-staff-current-approaches
#12
REVIEW
Nicola Ramacciati, Andrea Ceccagnoli, Beniamino Addey, Enrico Lumini, Laura Rasero
INTRODUCTION: The phenomenon of workplace violence in health care settings, and especially in the emergency department (ED), has assumed the dimensions of a real epidemic. Many studies highlight the need for methods to ensure the safety of staff and propose interventions to address the problem. AIM: The aim of this review was to propose a narrative of the current approaches to reduce workplace violence in the ED, with a particular focus on evaluating the effectiveness of emergency response programs...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27307768/clinical-decision-rules-for-acute-bacterial-meningitis-current-insights
#13
REVIEW
Alain Viallon, Elisabeth Botelho-Nevers, Fabrice Zeni
Acute community-acquired bacterial meningitis (BM) requires rapid diagnosis so that suitable treatment can be instituted within 60 minutes of admitting the patient. The cornerstone of diagnostic examination is lumbar puncture, which enables microbiological analysis and determination of the cerebrospinal fluid (CSF) cytochemical characteristics. However, microbiological testing is not sufficiently sensitive to rule out this diagnosis. With regard to the analysis of standard CSF cytochemical characteristics (polymorphonuclear count, CSF glucose and protein concentration, and CSF:serum glucose), this is often misleading...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27307767/success-of-applying-early-goal-directed-therapy-for-septic-shock-patients-in-the-emergency-department
#14
Panita Worapratya, Apisit Wanjaroenchaisuk, Jutharat Joraluck, Prasit Wuthisuthimethawee
BACKGROUND: Since early goal-directed therapy (EGDT) became standard care in severe sepsis and septic shock patients in intensive care units many years ago, we suppose that the survival rate of severe sepsis and septic shock patients improves if the resuscitative procedure is quickly implemented and is initiated in the emergency room. OBJECTIVE: We aimed at recording emergency department time to improve our patient care system as well as determine the rate at which EGDT goals can be achieved...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27147894/clinical-decision-aids-for-chest-pain-in-the-emergency-department-identifying-low-risk-patients
#15
REVIEW
William Alley, Simon A Mahler
Chest pain is one of the most common presenting complaints in the emergency department, though only a small minority of patients are subsequently diagnosed with acute coronary syndrome (ACS). However, missing the diagnosis has potential for significant morbidity and mortality. ACS presentations can be atypical, and their workups are often prolonged and costly. In order to risk-stratify patients and better direct the workup and care given, many decision aids have been developed. While each may have merit in certain clinical settings, the most useful aid in the emergency department is one that finds all cases of ACS while also identifying a substantial subset of patients at low risk who can be discharged without stress testing or coronary angiography...
2015: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27147893/canadian-triage-and-acuity-scale-testing-the-mental-health-categories
#16
Anne-Marie Brown, Diana E Clarke, Julia Spence
PURPOSE: The study tested the inter-rater reliability and accuracy of triage nurses' assignment of urgency ratings for mental health patient scenarios based on the 2008 Canadian Triage and Acuity Scale (CTAS) guidelines, using a standardized triage tool. The influence of triage experience, educational preparation, and comfort level with mental health presentations on the accuracy of urgency ratings was also explored. METHODS: Study participants assigned urgency ratings to 20 mental health patient scenarios in randomized order using the CTAS...
2015: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27147892/targeted-temperature-management-in-emergency-medicine-current-perspectives
#17
REVIEW
Benton R Hunter, Timothy J Ellender
Landmark trials in 2002 showed that therapeutic hypothermia (TH) after out-of-hospital cardiac arrest due to ventricular tachycardia or ventricular fibrillation resulted in improved likelihood of good neurologic recovery compared to standard care without TH. Since that time, TH has been frequently instituted in a wide range of cardiac arrest patients regardless of initial heart rhythm. Recent evidence has evaluated how, when, and to what degree TH should be instituted in cardiac arrest victims. We outline early evidence, as well as recent trials, regarding the use of TH or targeted temperature management in these patients...
2015: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27147891/emergency-surgery-in-the-elderly-challenges-and-solutions
#18
REVIEW
Andrew D W Torrance, Susan L Powell, Ewen A Griffiths
Elderly patients frequently present with surgical emergencies to health care providers, and outcomes in this group of patients remain poor. Contributing factors include frailty, preexisting comorbidity, polypharmacy, delayed diagnosis, and lack of timely and consultant-led treatment. In this review, we address common emergency surgical presentations in the elderly and highlight the specific challenges in caring for these patients. We summarize 20 years of reports by various medical bodies that have aimed to improve the care of these patients...
2015: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27147890/acute-care-of-older-patients-in-the-emergency-department-strategies-to-improve-patient-outcomes
#19
REVIEW
John J McCabe, Sean P Kennelly
Older patients in the emergency department (ED) are a vulnerable population who are at a higher risk of functional decline and hospital reattendance subsequent to an ED visit, and have a high mortality rate in the months following an ED attendance. The delivery of acute care in a busy environment to this population presents its own unique challenge. The purpose of this review is to detail the common geriatric syndromes encountered in the ED as well as the appropriate strategies and instruments, which can be utilized to support the clinical decision matrix and improve outcomes...
2015: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27147889/tumor-lysis-syndrome-in-the-emergency-department-challenges-and-solutions
#20
REVIEW
Silvio A Ñamendys-Silva, Juan M Arredondo-Armenta, Erika P Plata-Menchaca, Humberto Guevara-García, Francisco J García-Guillén, Eduardo Rivero-Sigarroa, Angel Herrera-Gómez
Tumor lysis syndrome (TLS) is the most common oncologic emergency. It is caused by rapid tumor cell destruction and the resulting nucleic acid degradation during or days after initiation of cytotoxic therapy. Also, a spontaneous form exists. The metabolic abnormalities associated with this syndrome include hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia, and acute kidney injury. These abnormalities can lead to life-threatening complications, such as heart rhythm abnormalities and neurologic manifestations...
2015: Open Access Emergency Medicine: OAEM
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