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Emergency department review

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https://www.readbyqxmd.com/read/29332187/human-bite-injuries-to-the-head-and-neck-current-trends-and-management-protocols-in-england-and-wales
#1
Glyndwr W Jenkins, Robert Isaac, Shakir Mustafa
INTRODUCTION: Human bite injuries can be challenging in their presentation to the examining physician. In a study by Merchant et al., 18% of patients presenting with a human bite injury had suffered wounds to the head and neck region. Current trends in their initial management at presentation to emergency departments throughout England and Wales will be discussed in this paper. MATERIALS AND METHOD: A postal survey was sent out to 100 A&E lead clinicians. This was followed up by telephone enquiries to improve the response rate...
January 14, 2018: Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29331979/now-you-see-me-a-pragmatic-cohort-study-comparing-first-and-final-radiological-diagnoses-in-the-emergency-department
#2
Björn Mattsson, David Ertman, Aristomenis Konstantinos Exadaktylos, Luca Martinolli, Wolf E Hautz
OBJECTIVES: To (1) compare timely but preliminary and definitive but delayed radiological reports in a large urban level 1 trauma centre, (2) assess the clinical significance of their differences and (3) identify clinical predictors of such differences. DESIGN, SETTING AND PARTICIPANTS: We performed a retrospective record review for all 2914 patients who presented to our university affiliated emergency department (ED) during a 6-week period. In those that underwent radiological imaging, we compared the patients' discharge letter from the ED to the definitive radiological report...
January 13, 2018: BMJ Open
https://www.readbyqxmd.com/read/29331493/hip-dislocations-in-the-emergency-department-a-review-of-reduction-techniques
#3
Michael Gottlieb
BACKGROUND: Hip dislocations are a common presentation in the Emergency Department (ED) and require urgent reduction to reduce the risk of avascular necrosis. Over 90% of all dislocations can successfully be reduced in the ED and there is evidence that cases awaiting operative reduction result in significant delays. DISCUSSION: While there is limited data comparing specific techniques, the individual success rates of most maneuvers range from 60-90%. Additionally, each technique has distinct advantages and limitations associated with its use...
January 10, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29328879/modeling-health-care-expenditures-and-use
#4
Partha Deb, Edward C Norton
Health care expenditures and use are challenging to model because these dependent variables typically have distributions that are skewed with a large mass at zero. In this article, we describe estimation and interpretation of the effects of a natural experiment using two classes of nonlinear statistical models: one for health care expenditures and the other for counts of health care use. We extend prior analyses to test the effect of the ACA's young adult expansion on three different outcomes: total health care expenditures, office-based visits, and emergency department visits...
January 12, 2018: Annual Review of Public Health
https://www.readbyqxmd.com/read/29326038/a-qualitative-meta-synthesis-of-emergency-department-staff-experiences-of-violence-and-aggression
#5
REVIEW
Rebecca Angharad Ashton, Lucy Morris, Ian Smith
INTRODUCTION: Patient and visitor violence or aggression against healthcare workers in the Emergency Department (ED) is a significant issue worldwide. This review synthesises existing qualitative studies exploring the first-hand experiences of staff working in the ED to provide insight into preventing this issue. METHOD: A meta-ethnographic approach was used to review papers. RESULTS: Four concepts were identified: 'The inevitability of violence and aggression'; 'Staff judgments about why they face violence and aggression'; 'Managing in isolation'; and 'Wounded heroes'...
January 8, 2018: International Emergency Nursing
https://www.readbyqxmd.com/read/29325441/five-year-experience-of-an-inpatient-palliative-care-unit-at-an-academic-referral-center
#6
Myrick C Shinall, Sara F Martin, Jill Nelson, Richard S Miller, Matthew W Semler, Eli E Zimmerman, Christy C Noblit, E Wesley Ely, Mohana Karlekar
BACKGROUND: Palliative care units (PCUs) staffed by specialty-trained physicians and nurses have been established in a number of medical centers. The purpose of this study is to review the 5-year experience of a PCU at a large, urban academic referral center. METHODS: We retrospectively reviewed a prospectively collected database of all admissions to the PCU at Vanderbilt University Medical Center in the first 5 years of its existence, from 2012 through 2017. RESULTS: Over these 5 years, there were 3321 admissions to the PCU...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29325162/an-analysis-of-adverse-events-in-the-rehabilitation-department-using-the-veterans-affairs-root-cause-analysis-system
#7
Gregory W Hagley, Peter D Mills, Brian Shiner, Robin R Hemphill
Background: Root cause analyses (RCA) are often completed in health care settings to determine causes of adverse events (AEs). RCAs result in action plans designed to mitigate future patient harm. National reviews of RCA reports have assessed the safety of numerous health care settings and suggested opportunities for improvement. However, few studies have assessed the safety of receiving care from physical therapists, occupational therapists, or speech and language pathology pathologists...
January 9, 2018: Physical Therapy
https://www.readbyqxmd.com/read/29324631/pediatric-appendicitis-association-of-chief-complaint-with-missed-appendicitis
#8
Zachary Drapkin, Jennifer Dunnick, Troy E Madsen, Matthew Bryce, Jeff E Schunk
OBJECTIVES: We evaluated the association between the emergency department (ED) triage chief complaint and rate of missed appendicitis in children. METHODS: We performed a retrospective chart review of patients who presented to a pediatric ED and were diagnosed with appendicitis over 5 years (July 1, 2009 to June 30, 2014). We reviewed the medical record for any additional ED visits in the 7 days preceding the diagnosis of appendicitis. Triage chief complaints were classified as "suggestive of appendicitis" (abdominal pain, right lower quadrant pain, or rule out appendicitis) or "nonspecific" (fever, vomiting, dehydration, etc)...
January 11, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29324529/inappropriately-timed-pediatric-orthopaedic-referrals-from-the-emergency-department-result-in-unnecessary-appointments-and-financial-burden-for-patients
#9
Taylor J Jackson, Todd J Blumberg, Apurva S Shah, Wudbhav N Sankar
BACKGROUND: Musculoskeletal injuries are among the most common reasons for emergency department (ED) visits in the pediatric population. Many such injuries can be managed with a single follow-up outpatient visit. However, untimely (ie, premature) referrals by emergency physicians to orthopaedic surgeons are common and may inadvertently create need for a second visit, generating unnecessary expenditures. We sought to elucidate the cost of premature musculoskeletal follow-up visits to the patients, families, and the health care system...
January 10, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29324173/the-risk-of-deterioration-in-gcs13-15-patients-with-traumatic-brain-injury-identified-by-computed-tomography-imaging-a-systematic-review-and-meta-analysis
#10
Carl Marincowitz, Fiona E Lecky, William Townend, Aditya Borakati, Andrea Fabbri, Trevor A Sheldon
The optimal management of mild traumatic brain injury (TBI) patients with injuries identified by computed tomography (CT) brain scan is unclear. Some guidelines recommend hospital admission for an observation period of at least 24 h. Others argue that selected lower-risk patients can be discharged from the Emergency Department (ED). The objective of our review and meta-analysis was to estimate the risk of death, neurosurgical intervention, and clinical deterioration in mild TBI patients with injuries identified by CT brain scan, and assess which patient factors affect the risk of these outcomes...
January 11, 2018: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29321255/multisite-emergency-department-inpatient-collaborative-to-reduce-unnecessary-bronchiolitis-care
#11
Grant M Mussman, Michele Lossius, Faiza Wasif, Jeffrey Bennett, Kristin A Shadman, Susan C Walley, Lauren Destino, Elizabeth Nichols, Shawn L Ralston
BACKGROUND AND OBJECTIVES: There is high variation in the care of acute viral bronchiolitis. We sought to promote collaboration between emergency department (ED) and inpatient (IP) units with the goal of reducing unnecessary testing and treatment. METHODS: Multisite collaborative with improvement teams co-led by ED and IP physicians and a 1-year period of active participation. The intervention consisted of a multicomponent change package, regular webinars, and optional coaching...
January 10, 2018: Pediatrics
https://www.readbyqxmd.com/read/29321120/evaluating-vancomycin-and-piperacillin-tazobactam-in-emergency-department-patients-with-severe-sepsis-and-septic-shock
#12
Christina Le, Frank Chu, Ronald Dunlay, Julian Villar, Peter Fedullo, Gabriel Wardi
STUDY OBJECTIVE: To determine the frequency and cause of inadequate initial antibiotic therapy with vancomycin and piperacillin-tazobactam in patients with severe sepsis and septic shock in the emergency department (ED), characterize its impact on patient outcomes, and identify patients who would benefit from an alternative initial empiric regimen. METHODS: Retrospective cohort study conducted between 2012 and 2015 in which 342 patients with culture-positive severe sepsis or septic shock who received initial vancomycin and piperacillin-tazobactam were reviewed to determine appropriateness of antimicrobial therapy, risk factors for inappropriate use, and outcome data...
December 29, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29321112/the-evaluation-and-management-of-urolithiasis-in-the-emergency-department-a-review-of-the-literature
#13
REVIEW
Michael Gottlieb, Brit Long, Alex Koyfman
BACKGROUND: Urolithiasis is a common condition in the U.S. Patients frequently present to the emergency department (ED) for care, including analgesia and treatments to facilitate stone passage. OBJECTIVE: With the new evidence concerning the evaluation and treatment of urolithiasis, this review summarizes current literature regarding the ED management of urolithiasis. DISCUSSION: Urolithiasis occurs primarily through supersaturation of urine and commonly presents with flank pain, hematuria, and nausea/vomiting...
January 5, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29321107/can-i-send-this-patient-with-stroke-home-strategies-managing-transient-ischemic-attack-and-minor-stroke-in-the-emergency-department
#14
Bernard P Chang, Sara Rostanski, Joshua Willey, Benjamin Kummer, Eliza Miller, Mitchell Elkind
BACKGROUND: While transient ischemic attack and minor stroke (TIAMS) are common conditions evaluated in the emergency department (ED), there is controversy regarding the most effective and efficient strategies for managing them in the ED. Some patients are discharged after evaluation in the ED and cared for in the outpatient setting, while others remain in an observation unit without being admitted or discharged, and others experience prolonged and potentially costly inpatient admissions...
January 8, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29321106/segway%C3%A2-personal-transporter-related-injuries-a-systematic-literature-review-and-implications-for-acute-and-emergency-care
#15
Ali Pourmand, Jen Liao, Jesse M Pines, Maryann Mazer-Amirshahi
BACKGROUND: The Segway® Personal Transporter™ (SPT) is used widely as a means of transport for city sightseeing tours, law enforcement, and professionals working in large facilities and factories. METHODS: We conducted a systematic review of the literature to assess SPT-related injuries. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, we queried PubMed from 1990 to 2017. The search terms Segway, personal transporter, and injury were used...
January 8, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29320603/drug-management-for-acute-tonic-clonic-convulsions-including-convulsive-status-epilepticus-in-children
#16
REVIEW
Amy McTague, Timothy Martland, Richard Appleton
BACKGROUND: Tonic-clonic convulsions and convulsive status epilepticus (currently defined as a tonic-clonic convulsion lasting at least 30 minutes) are medical emergencies and require urgent and appropriate anticonvulsant treatment. International consensus is that an anticonvulsant drug should be administered for any tonic-clonic convulsion that has been continuing for at least five minutes. Benzodiazepines (diazepam, lorazepam, midazolam) are traditionally regarded as first-line drugs and phenobarbital, phenytoin and paraldehyde as second-line drugs...
January 10, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29320313/acute-radiologic-manifestations-of-america-s-opioid-epidemic
#17
David D B Bates, Katherine Gallagher, HeiShun Yu, Jennifer Uyeda, Akira M Murakami, Bindu N Setty, Stephan W Anderson, Mariza O Clement
The United States is in the midst of an opioid use epidemic, which has severe medical, social, and economic consequences. Addictions to and abuse of prescription and illicit opioids are increasing, and emergency department radiologists are increasingly being faced with the task of examining patients who present with opioid-related complications. These complications may be the result of direct drug toxicity or nonsterile injection of the drugs. Neurologic, musculoskeletal, cardiopulmonary, genitourinary, and gastrointestinal complications may be evident at diagnostic imaging in emergent settings...
January 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/29319649/decreasing-radiation-exposure-in-pediatric-trauma-related-to-cervical-spine-clearance-a-quality-improvement-project
#18
Valerie Ann Waddell, Susan Connelly
STUDY DESIGN: Quality improvement project. OBJECTIVES: Reduce the amount of radiation exposure in the pediatric trauma population 5 years of age and older in relation to cervical spine clearance. BACKGROUND: The evaluation of pediatric cervical spine injuries must be accurate and timely to avoid missed injuries. The difficult clinical examination in pediatric trauma patients necessitates the use of radiologic examinations to avoid missing catastrophic injuries...
January 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/29319644/improving-thermoregulation-for-trauma-patients-in-the-emergency-department-an-evidence-based-practice-project
#19
Ada Saqe-Rockoff, Finn D Schubert, Amanda Ciardiello, Elizabeth Douglas
Extensive evidence exists on the association between hypothermia and increased morbidity and mortality in trauma patients. Gaps in practice related to temperature assessment have been identified in literature, along with limited personnel knowledge regarding management of patients with accidental hypothermia. An interdisciplinary team identified gaps in practice in our institution regarding temperature assessment and documentation of rewarming and initiated an evidence-based practice project to change practice at our institution...
January 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/29318927/cost-effectiveness-of-evaluation-of-children-with-epilepsy-in-the-emergency-department-need-for-investment-in-patient-education
#20
Karen S Carvalho, Anthony L Fine, Christopher J Haines, Ignacio Valencia, Divya S Khurana, Agustin Legido
We aimed to study cost-effectiveness of seizure evaluation of children with epilepsy in the emergency department (ED). We reviewed epilepsy patients seen at our ED for 1 year. Age, laboratory and neuroimaging results, treatment, disposition, and usefulness of the visit (need for hospitalization, clinical improvement) were analyzed. We identified 330 patients, aged 23 days-21 years, 190 (57.5%) had blood tests, 45 (13.6%) urinalysis, 2 (0.6%) cerebrospinal fluid testing, and 44 neuroimaging studies (13.3%)...
January 1, 2018: Journal of Child Neurology
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