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ED critical care

Prashant Parulekar, Ed Neil-Gallacher, Alex Harrison
Acute kidney injury is common in critically ill patients, with ultrasound recommended to exclude renal tract obstruction. Intensive care unit clinicians are skilled in acquiring and interpreting ultrasound examinations. Intensive Care Medicine Trainees wish to learn renal tract ultrasound. We sought to demonstrate that intensive care unit clinicians can competently perform renal tract ultrasound on critically ill patients. Thirty patients with acute kidney injury were scanned by two intensive care unit physicians using a standard intensive care unit ultrasound machine...
November 2018: Journal of the Intensive Care Society
F McNicholas, C O'Connor, N McNamara, L O'Hara
OBJECTIVES: This paper illuminates how national eating disorder (ED) policy translates into day-to-day practice by exploring how ED services are experienced by those who deliver and use them. METHODS: A mixed-methods approach was used, which combined qualitative and quantitative techniques. The paper collates data from three studies: (i) an interview study exploring the lived experiences of young people with EDs (n=8), their parents (n=5) and their healthcare professionals (n=3); (ii) a national survey of health professionals' perspectives on existing ED services (n=171); (iii) a nationwide survey of secondary-school students' eating concerns and patterns of help-seeking (n=290)...
December 2018: Irish Journal of Psychological Medicine
Bianca Masuku, Nolwazi Mkhwanazi, Ed Young, Anastasia Koch, Digby Warner
Eh!woza is a public engagement initiative that explores the biomedical and social aspects of tuberculosis (TB) in South Africa. The project is a collaboration between scientists based in an infectious disease research institute, a local conceptual/visual artist, a youth-based educational non-governmental organization (NGO) and young learners from a high-burden TB community. The learners participate in a series of interactive science and media production workshops: initially presented with biomedical knowledge about TB and, in later sessions, are trained in creating documentary films and engage with ideas around visual representation...
December 2018: Medical Humanities
Nizar K Wehbi, Rajvi Wani, Yangyuna Yang, Fernando Wilson, Sharon Medcalf, Brian Monaghan, Jennifer Adams, Paul Paulman
Background: Training emergency medical services (EMS) workforce is challenging in rural and remote settings. Moreover, critical access hospitals (CAHs) struggle to ensure continuing medical education for their emergency department (ED) staff. This project collected information from EMS and ED providers across Nebraska to identify gaps in their skills, knowledge, and abilities and thus inform curriculum development for the mobile simulation-based training program. Methods: The needs assessment used a three-step process: (1) four facilitated focus group sessions were conducted in distinct geographical locations across Nebraska to identify participants' perceived training gaps; (2) based on the findings from the focus group, a needs assessment survey was constructed and sent to all EMS and ED staff in Nebraska; and (3) 1395 surveys were completed and analyzed...
2018: Advances in Simulation
Ester Góes Oliveira, Paulo Carlos Garcia, Clairton Marcos Citolino Filho, Lilia de Souza Nogueira
BACKGROUND: The results of studies regarding the relationship between length of stay of patients in emergency departments (EDs) and mortality in intensive care units (ICUs) are contradictory, and nothing is known about the impact of delayed admission of patients to ICUs on nursing workload. AIMS AND OBJECTIVES: To assess the influence of the time lapse between ED and ICU admissions on mortality and nursing workload in relation to intensive care patients. DESIGN: This was a retrospective cohort study that examined the medical records of patients who were 15 years of age or older and admitted directly to the ICU from the ED...
November 26, 2018: Nursing in Critical Care
Holly E Depinet, Michelle Eckerle, Olga Semenova, Jareen Meinzen-Derr, Lynn Babcock
OBJECTIVE: To inform the future development of a pediatric prehospital sepsis tool, we sought to 1) describe the characteristics, emergent care, and outcomes for children with septic shock who are transported by emergency medicine services (EMS) and compare them to those self-transported; and 2) determine the EMS capture rate of common sepsis screening parameters and the concordance between the parameters documented in the EMS record and in the emergency department (ED) record. METHODS: This is a retrospective cohort study of children ages 0 through 21 years who presented to a pediatric ED with septic shock between 11/2013 and 06/2016...
November 15, 2018: Prehospital Emergency Care
Kapil Dev Soni, Gaurav Kaushik, Amit Gupta, Vishwajeet Singh, Subodh Kumar, Sushma Sagar
Introduction: Emergency department (ED) overcrowding with critically ill trauma patients has been a major concern globally. It has been shown that longer stays in the hospital before Intensive Care Unit (ICU) admission have a higher mortality rate. Objective: The objective of this study was to find whether the delay in ICU admission from ED is associated with significant mortality in a trauma patient. Methods: A prospective trauma registry data of 232 patients collected from the ED of JPNATC trauma center between September 2015 and March 2016 were used in the study...
July 2018: Journal of Emergencies, Trauma, and Shock
K Kc Hung, R Pk Lam, R Sl Lo, J W Tenney, M Lc Yang, M Ck Tai, C A Graham
INTRODUCTION: Emergency departments (EDs) play an important role in the early identification and management of sepsis. Little is known about local EDs' processes of care for sepsis, adoption of international recommendations, and the impact of the new Sepsis-3 definitions. METHODS: Structured telephone interviews based on the United Kingdom Sepsis Trust 'Exemplar Standards for the Emergency Management of Sepsis' were conducted from January to August 2017 with nominated representatives of all responding public hospital EDs in Hong Kong, followed by a review of hospital/departmental sepsis guidelines by the investigators...
November 14, 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Justin Wang, Khai Pin Lee, Shu-Ling Chong, Mervin Loi, Jan Hau Lee
Heated humidified high flow nasal cannula therapy (HHHFNCT) is emerging as a popular non-invasive mode of respiratory support in adults and children. In recent years, its use has extended beyond the intensive care unit to other clinical areas. This review aims to explore the mechanism of action, indications, safety, and effectiveness of HHHFNCT use in the Emergency Department (ED). Areas covered: The mechanism of action of HHHFNCT, as well as its use in adult and pediatric ED will be discussed in this review...
November 14, 2018: Expert Review of Medical Devices
Jeffrey Gardecki, Kishan Patel, Omid Rowshan
Thoracic ultrasound has become an increasingly valuable tool in the evaluation of critically ill patients in the emergency department (ED). The utility of point-of-care ultrasound (POCUS) to identify suspected pneumothorax, pulmonary edema, pleural effusion and pneumonia has been well established (Pagano et al.; Brogi et al.; Cortellaro et al.; Irwin and Cook [1-4]). The 2014 American College of Emergency Physicians (ACEP) Ultrasound Imaging Compendium included lung and pleural ultrasound with the primary indication of identifying pneumothorax and pleural effusion as part of the core POCUS indications for all emergency physicians [5]...
October 26, 2018: American Journal of Emergency Medicine
David Kinas, Michael Dalley, Kayla Guidry, Mark A Newberry, David A Farcy
We describe a case of a young male who presents to the emergency department with severe sepsis and decompensated heart failure with underlying Methamphetamine-Associated Cardiomyopathy that was previously undiagnosed. This presentation is unique because Methamphetamine-Associated Cardiomyopathy is an uncommonly reported condition that presented in a complex clinical scenario of severe sepsis and decompensated congestive heart failure. We discuss how we used point-of-care ultrasound (POCUS) in this case to identify an unsuspected disease process and how it changed our initial resuscitation strategy and management...
2018: Case Reports in Emergency Medicine
Jessica S Roche, Michael J Clery, Patrick M Carter, Aaron Dora-Laskey, Maureen A Walton, Quyen M Ngo, Rebecca M Cunningham
OBJECTIVES: Violence is one of the leading causes of death among youth ages 14 to 24. Hospital- and emergency department (ED)-based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidence-based best practices. Retention of study participants is key to evaluations, although little literature exists regarding optimizing follow-up methods for violently injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hard-to-reach participants...
October 31, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Paibul Suriyawongpaisal, Pongsakorn Atiksawedparit, Samrit Srithamrongsawad, Thanita Thongtan
Background: Previous policy implementation in 2012 to incentivize private hospitals in Thailand, a country with universal health coverage, to provide free-of-charge emergency care using DRG-based payment resulted in an equity gap of access and copayment. To bridge the gap, strategic policies involving financial and legal interventions were implemented in 2017. This study aims to assess whether this new approach would be able to fill the gap. Methods: We analyzed an administrative dataset of over 20,206 patients visiting private hospital EDs from April 2017 to October 2017 requested for the preauthorization of access to emergency care in the first 72 hours free of charge...
2018: Emergency Medicine International
Esmat Swallmeh, Vivienne Byers, Amr Arisha
PURPOSE: Assessing performance and quality in healthcare organisations is moving from focussing solely on clinical care measurement to considering the patient experience as critical. Much patient experience research is quantitative and survey based. The purpose of this paper is to report a qualitative study gathering in-depth data in an emergency department (ED). DESIGN/METHODOLOGY/APPROACH: The authors used empirical data from seven focus groups to understand patient experience as participants progressed through a major teaching hospital in an Ireland ED...
August 13, 2018: International Journal of Health Care Quality Assurance
Martin Cota, Anita Moses, Neekita Jikaria, Katie Bittner, Ramon Diaz-Arrastia, Lawrence Latour, L Christine Turtzo
Accurate diagnosis of traumatic brain injury (TBI) is critical to ensure patients receive appropriate follow-up care, avoid risk of subsequent injury, and are aware of possible long-term consequences. However, diagnosis of TBI, particularly in the emergency department (ED), can be difficult because the symptoms of TBI are vague and nonspecific, and patients with suspected TBI may present with additional injuries that require immediate medical attention. We performed a retrospective chart review to evaluate accuracy of TBI diagnosis in the ED...
October 23, 2018: Journal of Neurotrauma
Erin L Simon, Sunita Shakya, Louisa Liu, Greg Griffin, Courtney M Smalley, Seth Podolsky, Rakesh Engineer
BACKGROUND: Freestanding emergency departments (FEDs) care for all patients, including critically ill, 24/7/365. We characterized patients from three FEDs transferred to intensive care units (ICU) at a tertiary care hospital, and compared hospital length of stay(LOS) between patients admitted to ICUs from FEDs versus a hospital-based ED (HBED). METHODS: We performed a retrospective, observational cohort study from January 2014 to December 2016. Demographic and clinical information was compared between FED and HBED patients with chi-square and fisher's exact tests for categorical variables and Student's t-test for continuous variables...
October 11, 2018: American Journal of Emergency Medicine
Joon-Myoung Kwon, Youngnam Lee, Yeha Lee, Seungwoo Lee, Hyunho Park, Jinsik Park
AIM: Triage is important in identifying high-risk patients amongst many less urgent patients as emergency department (ED) overcrowding has become a national crisis recently. This study aims to validate that a Deep-learning-based Triage and Acuity Score (DTAS) identifies high-risk patients more accurately than existing triage and acuity scores using a large national dataset. METHODS: We conducted a retrospective observational cohort study using data from the Korean National Emergency Department Information System (NEDIS), which collected data on visits in real time from 151 EDs...
2018: PloS One
Hadi Hassankhani, Amin Soheili, Samad S Vahdati, Farough A Mozaffari, Justin F Fraser, Neda Gilani
STUDY OBJECTIVE: We evaluate the extent and nature of treatment delays and the contributing factors influencing them for patients with acute ischemic stroke, as well as main barriers to stroke care in an Iranian emergency department (ED). METHODS: A retrospective chart review was conducted on 394 patients with acute ischemic stroke who were referred to the ED of a tertiary academic medical center in northwest Iran from March 21 to June 21, 2017. The steps of this review process included instrument development, medical records retrieval, data extraction, and data verification...
October 11, 2018: Annals of Emergency Medicine
Michael Pulia, Robert Redwood, Larissa May
The emergency department (ED) is the hub of the US health care system. Acute infectious diseases are frequently encountered in the ED setting, making this a critical setting for antimicrobial stewardship efforts. Systems level and behavioral stewardship interventions have demonstrated success in the ED setting but successful implementation depends on institutional support and the presence of a physician champion. Antimicrobial stewardship efforts in the ED should target high-impact areas: antibiotic prescribing for nonindicated respiratory tract conditions, such as bronchitis and sinusitis; overtreatment of asymptomatic bacteriuria; and using two antibiotics (double coverage) for uncomplicated cases of cellulitis or abscess...
November 2018: Emergency Medicine Clinics of North America
Jiha Lee, Judith Lin, Lisa Gale Suter, Liana Fraenkel
OBJECTIVE: To evaluate SLE patients who persistently frequent the ED to identify opportunities to improve outpatient care. METHODS: We conducted a retrospective study of SLE patients who frequented the ED for ≥3 visits in a calendar year from 2013-2016. Persistent users met criteria for frequent use for at least 2 out of the 4 years, and limited users for 1 out of the 4 years. Each ED encounter was categorized as; SLE-, infection-, pain- related, or "other"...
October 8, 2018: Arthritis Care & Research
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