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https://www.readbyqxmd.com/read/29351496/implementation-of-a-prehospital-protocol-change-for-asthmatic-children
#1
Anriada Nassif, Daniel G Ostermayer, Kim B Hoang, Mary K Claiborne, Elizabeth A Camp, Manish I Shah
BACKGROUND: Respiratory distress due to asthma is a common reason for pediatric emergency medical services (EMS) transports. Timely initiation of asthma treatment, including glucocorticoids, improves hospital outcomes. The impact of EMS-administered glucocorticoids on hospital-based outcomes for pediatric asthma patients is unknown. OBJECTIVE: The objective of this study was to evaluate the effect of an evidence-based pediatric EMS asthma protocol update, inclusive of oral glucocorticoid administration, on time to hospital discharge...
January 19, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29351141/an-exploration-of-emergency-physicians-attitudes-toward-patients-with-substance-use-disorder
#2
Cecelia Kathleen Mendiola, Giorgio Galetto, Michael Fingerhood
OBJECTIVES: Much is known about some healthcare professionals' attitudes toward patients with substance use disorders, but few studies have specifically looked at emergency department (ED) physicians. Individuals with substance use disorders are more likely to be people who chronically, frequently use the ED, and thus ED physicians are in a unique position to provide early identification and intervention for people struggling with addiction. The purpose of this study was to understand ED physicians' attitudes toward patients with substance use disorder with the aim of decreasing stigma and improving the care of ED patients with substance use disorder...
January 18, 2018: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/29350674/takotsubo-cardiomyopathy-in-an-ultra-centenarian-woman
#3
Laura Bonfanti, Silvia Buratti, Luigi Vignali, Giuseppe Lippi, Franco Masini, Michele Bianconcini, Gianfranco Cervellin
A 101 years-old woman was admitted to our Emergency Department (ED) for acute dyspnea which onset nearly two hours before presentation. She had been on hydrochlorothyazyde-amiloride therapy due to mild hypertension. No other relevant features were present in the clinical history. The old lady had never been admitted to the hospital, and she was still living alone. A few days before hospital admission, one of the daughters became ill, so that a caregiver was paid for assisting her 12/24. This new circumstance was reluctantly accepted by the old lady...
January 16, 2018: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/29350673/glyphosate-ingestion-causing-multiple-organ-failure-a-near-fatal-case-report
#4
Edoardo Picetti, Michela Generali, Francesca Mensi, Giampaolo Neri, Roberta Damia, Giuseppe Lippi, Gianfranco Cervellin
A 55 years old man self-presented to our Emergency Department (ED) reporting an attempted suicide by cutting the left forearm veins and ingesting approximately 200 mL of an herbicide (Myrtos®, containing 36% of glyphosate as isopropylamine salt). Laboratory tests showed metabolic acidosis. Hydration with normal saline and alkalinization with sodium bicarbonate was started according to suggestion of the poison control center, since an antidote was unavailable. Cardiorespiratory condition gradually worsened, so that non-invasive positive pressure ventilation (NIPPV) was applied and infusion of fluids was established...
January 16, 2018: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/29350672/rebounds-after-discharge-from-the-emergency-department-for-community-acquired-pneumonia-focus-on-the-usefulness-of-severity-scoring-systems
#5
Rodolfo Ferrari, Pierluigi Viale, Paolo Muratori, Fabrizio Giostra, Daniela Agostinelli, Roberto Lazzari, Riccardo Voza, Mario Cavazza
BACKGROUND: Community-acquired pneumonia (CAP) is common cause of hospital admission and leading cause of morbidity and mortality. Severity scoring systems are used to predict risk profile, outcome and mortality, and to help decisions about management strategies. Aim of the work and Methods: To critically analyze pneumonia "rebound" cases, once discharged from the emergency department (ED) and afterwards admitted. We conducted an observational clinical study in the acute setting of a university teaching hospital, prospectively analyzing, in a 1 year period, demographic, medical, clinical and laboratory data, and the outcome...
January 16, 2018: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/29350671/visits-for-alcohol-related-problems-in-a-large-urban-emergency-department-results-of-a-15-year-survey
#6
Ivan Comelli, Giuseppe Lippi, Fabian Sanchis-Gomar, Gianni Turcato, Gianfranco Cervellin
Alcohol abuse is associated with a high burden of morbidity and mortality. Nevertheless, definitive epidemiological data on alcohol-related visits in the emergency department (ED) is substantially lacking. This study was aimed to analyze the epidemiological patterns and temporal trends of alcohol-related visits in the local ED, and assessing the healthcare burden of cases needing hospital admission. All patients visited for alcohol-related problems between the years 2002-2016 were anonymously identified from the hospital database...
January 16, 2018: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/29350641/traumatic-fractures-in-adults-missed-diagnosis-on-plain-radiographs-in-the-emergency-department
#7
Antonio Pinto, Daniela Berritto, Anna Russo, Federica Riccitiello, Martina Caruso, Maria Paola Belfiore, Vito Roberto Papapietro, Marina Carotti, Fabio Pinto, Andrea Giovagnoni, Luigia Romano, Roberto Grassi
Radiography remains the imaging standard for fracture detection after trauma. The radiographic diagnosis of most fractures and dislocations poses little difficulty to radiologists: however, occasionally these injuries are quite subtle or even impossible to detect on radiographs. Missed diagnoses of fracture potentially have important consequences for patients, clinicians, and radiologists. Radiologists play a pivot role in the diagnostic assessment of the trauma patients: emergency radiologists who are more practiced at seeking out and discerning traumatic fractures can provide an invaluable service to their clinical colleagues by ensuring that patients do not endure delayed diagnoses...
January 19, 2018: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/29350536/diagnostic-accuracy-of-functional-imaging-and-biochemical-tests-for-patients-presenting-with-chest-pain-to-the-emergency-department-a-systematic-review-and-meta-analysis
#8
Mario Iannaccone, Sebastiano Gili, Ovidio De Filippo, Salvatore D'Amico, Marco Gagliardi, Maurizio Bertaina, Silvia Mazzilli, Sara Rettegno, Federica Bongiovanni, Paolo Gatti, Fabrizio Ugo, Giacomo G Boccuzzi, Salvatore Colangelo, Silvia Prato, Claudio Moretti, Maurizio D'Amico, Patrizia Noussan, Roberto Garbo, David Hildick-Smith, Fiorenzo Gaita, Fabrizio D'Ascenzo
BACKGROUND: Non-invasive ischaemia tests and biomarkers are widely adopted to rule out acute coronary syndrome in the emergency department. Their diagnostic accuracy has yet to be precisely defined. METHODS: Medline, Cochrane Library CENTRAL, EMBASE and Biomed Central were systematically screened (start date 1 September 2016, end date 1 December 2016). Prospective studies (observational or randomised controlled trial) comparing functional/imaging or biochemical tests for patients presenting with chest pain to the emergency department were included...
January 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29350511/a-cost-effectiveness-analysis-of-cardiology-econsults-for-medicaid-patients
#9
Daren Anderson, Victor Villagra, Emil N Coman, Ianita Zlateva, Alex Hutchinson, Jose Villagra, J Nwando Olayiwola
OBJECTIVES: To evaluate the cost-effectiveness of electronic consultations (eConsults) for cardiology compared with traditional face-to-face consults. STUDY DESIGN: Cost-effectiveness analysis for a subset of Medicaid-insured patients in a cluster-randomized trial of eConsults versus the traditional face-to-face consultation process in a statewide federally qualified health center. METHODS: A total of 369 Medicaid patients were referred for cardiology consultations by primary care providers who were randomly assigned to use either eConsults or their usual face-to-face referral process...
January 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29350253/direct-transfer-of-stemi-patients-to-cardiac-catheterization-laboratory-prognostic-relevance-for-in-hospital-mortality
#10
M Ali, S A Lange, T Wittlinger, G Lehnert, S Behrend, B Ziadeh, K Ali, S Sakellaropoulos, G Ganchev, A G Rigopoulos, M Noutsias
BACKGROUND: Although the incidence of acute myocardial infarction and in-hospital mortality after ST-elevation myocardial infarction (STEMI) has declined substantially in countries that have established primary percutaneous coronary interventions (pPCI) over the past two decades, coronary artery disease remains a major cause of morbidity and mortality worldwide. We aimed to examine whether the direct transfer of STEMI patients to the cardiac catheterization laboratory (CCL) had a prognostic effect on in-hospital mortality in patients who underwent pPCI after STEMI...
January 19, 2018: Herz
https://www.readbyqxmd.com/read/29350116/-upper-abdominal-pain-after-an-elective-aortic-valve-replacement
#11
R M A van der Boon, M E Emans, S K Zoet
A 69-year-old man came to our emergency department with nausea, vomiting and upper abdominal pain under the suspicion of an ileus. Four weeks before he had had an elective aortic valve replacement. The basal thoracic slides of the abdominal CT-scan revealed a significant amount of pericardial effusion, after which the patient was referred for emergency cardiac surgery. Abdominal complaints are rarely the primary symptoms of severe heart failure.
2018: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/29349680/ultrasound-evaluation-of-the-airway-in-the-ed-a-feasibility-study
#12
Elizabeth A Hall, Ibrahim Showaihi, Frances S Shofer, Nova L Panebianco, Anthony J Dean
BACKGROUND: Recognition of the difficult airway is a critical element of emergency practice. Mallampati score and body mass index (BMI) are not always predictive and they may be unavailable in critically ill patients. Ultrasonography provides high-resolution images that are rapidly obtainable, mobile, and non-invasive. Studies have shown correlation of ultrasound measurements with difficult laryngoscopy; however, none have been performed in the Emergency Department (ED) using a consistent scanning protocol...
January 18, 2018: Critical Ultrasound Journal
https://www.readbyqxmd.com/read/29349639/outcomes-in-syncope-research-a-systematic-review-and-critical-appraisal
#13
Monica Solbiati, Viviana Bozzano, Franca Barbic, Giovanni Casazza, Franca Dipaola, James V Quinn, Matthew J Reed, Robert S Sheldon, Win-Kuang Shen, Benjamin C Sun, Venkatesh Thiruganasambandamoorthy, Raffaello Furlan, Giorgio Costantino
Syncope is the common clinical manifestation of different diseases, and this makes it difficult to define what outcomes should be considered in prognostic studies. The aim of this study is to critically analyze the outcomes considered in syncope studies through systematic review and expert consensus. We performed a systematic review of the literature to identify prospective studies enrolling consecutive patients presenting to the Emergency Department with syncope, with data on the characteristics and incidence of short-term outcomes...
January 18, 2018: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29349422/hybrid-management-of-a-ruptured-right-subclavian-artery-aneurysm-dissection
#14
David Drullinsky, Heather Gill, Jason P Bayne, Jean-Francois Morin, Daniel Obrand
Aberrant right subclavian artery is the most common congenital malformation of the aortic arch (0.4%-2.0%). Aneurysms of aberrant subclavian arteries are extremely rare. This results in little experience with their treatment. We describe a case of a patient who presented to the emergency department with a dissection of an aberrant right subclavian artery that later progressed to rupture. Besides hemodynamic instability, this caused an acute superior vena cava syndrome, making airway control difficult. In the operating room, we obtained proximal control through thoracic endovascular aortic repair; median sternotomy was performed for distal control and evacuation of massive hemomediastinum...
December 2017: Journal of Vascular Surgery Cases and Innovative Techniques
https://www.readbyqxmd.com/read/29349401/staged-reconstruction-of-the-inferior-vena-cava-after-gunshot-injury
#15
Nathan M Droz, John K Bini, Kamran A Jafree, John H Matsuura
A 23-year-old man with a gunshot injury to the abdomen and cardiac arrest requiring emergency department thoracotomy had a transection of the distal inferior vena cava (IVC) and small bowel injury. Because of persistent hemorrhagic shock, the IVC was ligated. During the next 3 days, he developed worsening bilateral leg edema. He was taken back for reanastomosis of his small bowel and reconstruction of the IVC using autologous femoral vein harvested from the right leg. We think that patients requiring ligation of the vena cava with worsening leg edema can benefit from a staged reconstruction of the IVC...
September 2017: Journal of Vascular Surgery Cases and Innovative Techniques
https://www.readbyqxmd.com/read/29349374/utilization-of-arterial-grafts-in-foot-replantation
#16
Selami S Sirvan, Daghan Dagdelen, Isil Akgun Demir, Mecd Atif Cezairlioglu, Hasan Basri Sezer, Semra Karsidag
Our subject is a 36-year-old man who presented to the emergency department with bilateral lower extremity amputation at the level of the distal third of the tibia after a car accident. Surgery was planned for below-knee amputation of the right lower extremity and replantation of the left foot. The arteries dissected from the iatrogenically amputated segment were used as grafts to repair vascular gaps during the replantation. The patient's follow-up had been problem free. We concluded that whenever possible, amputated parts unsuitable for replantation should be examined thoroughly and neurovascular structures that might be used as grafts should be preserved...
March 2017: Journal of Vascular Surgery Cases and Innovative Techniques
https://www.readbyqxmd.com/read/29349249/the-differential-effects-of-rural-health-care-access-on-race-specific-mortality
#17
Jeralynn Cossman, Wesley James, Julia Kay Wolf
We examined the relationship between race-specific rural mortality and the health infrastructure of rural counties in light of America's recent emergence of a rural mortality penalty. Using the Compressed Mortality File from National Center for Health Statistics (2008-2012) and county-level demographic, socioeconomic, and health care indicators from the Area Health Resource File and the US Census, we created a rural public health infrastructure index which encompasses four types of health care access (public health employees, critical access hospital/rural referral centers, rural health clinics, and emergency departments) within counties...
December 2017: SSM—Population Health
https://www.readbyqxmd.com/read/29348990/hypercalcemia-of-malignancy-an-emergency-medicine-simulation
#18
Raman Sohi, Gillian Sheppard
Hypercalcemia is a poor prognostic factor associated with malignancy. The signs and symptoms of hypercalcemia that the patients present to the emergency department are vague and often overlap with the general symptoms of cancer itself or the adverse effects of the chemotherapy. Given that the development of hypercalcemia of malignancy can present with imminent danger to the patient and is a treatable condition, emergency physicians should know how to recognize and treat it. It also marks a time at which discussions regarding plans of care should be initiated with the patients...
November 15, 2017: Curēus
https://www.readbyqxmd.com/read/29348283/unusual-feathery-cause-of-a-parapharyngeal-abscess-in-an-infant
#19
Wai Sum Cho, Mihaela Nistor, Kishan Ubayasiri, Mark Johnston
A 7-month-old boy presented to the emergency department with reduced oral intake, neck swelling and fever. Clinical examination revealed a 3 cm left parotid and left level I neck swelling with left medialised tonsil but no trismus. Computed imaging confirmed the presence of an abscess in the peritonsillar area with extension into the parapharyngeal space and deep lobe of the parotid gland. The abscess was incised and drained transorally. Following drainage of the abscess, a small 3 mm suspicious foreign body was seen...
January 17, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29347982/emergency-department-hyperoxia-is-associated-with-increased-mortality-in-mechanically-ventilated-patients-a-cohort-study
#20
David Page, Enyo Ablordeppey, Brian T Wessman, Nicholas M Mohr, Stephen Trzeciak, Marin H Kollef, Brian W Roberts, Brian M Fuller
BACKGROUND: Providing supplemental oxygen is fundamental in the management of mechanically ventilated patients. Increasing amounts of data show worse clinical outcomes associated with hyperoxia. However, these previous data in the critically ill have not focused on outcomes associated with brief hyperoxia exposure immediately after endotracheal intubation. Therefore, the objectives of this study were to evaluate the impact of isolated early hyperoxia exposure in the emergency department (ED) on clinical outcomes among mechanically ventilated patients with subsequent normoxia in the intensive care unit (ICU)...
January 18, 2018: Critical Care: the Official Journal of the Critical Care Forum
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