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https://www.readbyqxmd.com/read/28295894/cost-effectiveness-analysis-appraisal-and-application-an-emergency-medicine-perspective
#1
Michael D April, Brian P Murray
Cost-effectiveness is an important goal for emergency care delivery. The many diagnostic, treatment, and disposition decisions made in the emergency department (ED) have a significant impact upon healthcare resource utilization. Cost-effectiveness analysis (CEA) is an analytic tool to optimize these resource allocation decisions through the systematic comparison of costs and effects of alternative healthcare decisions. Yet few emergency medicine leaders and policy-makers have any formal training in CEA methodology...
March 10, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28292545/adding-fuel-to-the-fire-coronary-artery-dissection-complicating-blunt-chest-trauma
#2
Ankit Maheshwari, Thenappan Thenappan, Gladwin Das
A 21year-old male presented to the emergency department with 6 h of atypical chest pain after suffering blunt chest trauma. His electrocardiogram revealed 1-1.5mm ST segment elevation in leads V1-V3 with reciprocal depressions in II, III, and aVF. Mid-anterior wall akinesis was observed on echocardiography associated with an estimated left ventricular ejection fraction of 40%. A left main coronary artery dissection was diagnosed and treated surgically with a bypass graft. Although rare, coronary dissections can be a catastrophic complication of chest trauma...
March 7, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28289555/gender-differences-in-post-traumatic-stress
#3
Maria Grazia Modena, Daniele Pettorelli, Giulia Lauria, Elisa Giubertoni, Erminio Mauro, Valentina Martinotti
Acute stress can trigger cardiovascular events and disease. The earthquake is an "ideal" natural experiment for acute and chronic stress, with impact mainly on the cardiovascular system. On May 20th and 29th, 2012, two earthquakes of magnitude 5.9° to 6.4° on the Richter scale, hit the province of Modena and Reggio Emilia, an area of the north-center of Italy never considered at seismic risk. The purpose of our study was to assess whether there were gender-specific differences in stress-induced incidence of cardiovascular events and age of patients who arrived at the Emergency Departments (ED) of the three main teaching hospitals of the University of Modena and Reggio Emilia...
2017: BioResearch Open Access
https://www.readbyqxmd.com/read/28286847/protocol-adherence-in-prehospital-medical-care-provided-for-patients-with-chest-pain-and-loss-of-consciousness-a-brief-report
#4
Mostafa Mehrara, Nader Tavakoli, Marzieh Fathi, Babak Mahshidfar, Mohammad Amin Zare, Azita Asadi, Saeedeh Hosseinzadeh, Mehdi Safdarian
INTRODUCTION: Although many protocols are available in the field of the prehospital medical care (PMC), there is still a notable gap between protocol based directions and applied clinical practice. This study measures the rate of protocol adherence in PMC provided for patients with chest pain and loss of consciousness (LOC). METHOD: In this cross-sectional study, 10 educated research assistants audited the situation of provided PMC for non-traumatic chest pain and LOC patients, presenting to the emergency department of a tertiary level teaching hospital, compare to national recommendations in these regards...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28286818/validation-of-the-north-american-chest-pain-rule-in-prediction-of-very-low-risk-chest-pain-a-diagnostic-accuracy-study
#5
Somayeh Valadkhani, Mohammad Jalili, Elham Hesari, Hadi Mirfazaelian
INTRODUCTION: Acute coronary syndrome accounts for more than 15% of the chest pains. Recently, Hess et al. developed North American Chest Pain Rule (NACPR) to identify very low-risk patients who can be safely discharged from emergency department (ED). The present study aimed to validate this rule in EDs of two academic hospitals. METHODS: A prospective diagnostic accuracy study was conducted on consecutive patients 24 years of age and older presenting to the ED with the chief complaint of acute chest pain, during March 2013 to June 2013...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28282711/abdominal-pain-as-extrapulmonary-presentation-of-pneumonia-in-an-adult-a-case-report
#6
Hamid Emadi Koochak, Elnaz Tabibian, Shahram Rahimi Dehgolan
Pneumonia is considered as the main cause of abdominal pain in children whereas it presents mostly by respiratory symptoms in adults. Here we present a 71-year-old Iranian female who complained specifically of abdominal pain on admission to our emergency department. We had found nothing as an etiology in our first evaluations. After several hours chest pain was added to the symptoms and the following chest, X-Ray showed a consolidation in the right lung base. She was treated by pneumonia antibiotic regimen and discharged after seven days in a good clinical condition...
February 2017: Acta Medica Iranica
https://www.readbyqxmd.com/read/28281431/the-accuracy-of-nurse-performance-of-the-triage-process-in-a-tertiary-hospital-emergency-department-in-gauteng-province-south-africa
#7
L N Goldstein, L M Morrow, T A Sallie, K Gathoo, K Alli, T M M Mothopeng, F Samodien
BACKGROUND: Triage in the emergency department (ED) is necessary to prioritise management according to the severity of a patient's condition.The South African Triage Scale (SATS) is a hospital-based triage tool that has been adopted by numerous EDs countrywide.Many factors can influence the outcome of a patient's triage result, and evaluation of performance is therefore pivotal. OBJECTIVES: To determine how often patients were allocated to the correct triage category and the extent to which they were incorrectly promoted or demoted, and to determine the main reasons for errors in a nurse-led triage system...
February 27, 2017: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/28279544/inferior-vena-cava-filter-limb-fracture-with-embolization-to-the-right-ventricle
#8
Bradley S Jackson, Mykel Sepula, Jared T Marx, Chad M Cannon
BACKGROUND: Inferior vena cava (IVC) filter and filter limb embolization is a known phenomenon, with a prevalence of up to 25% for certain filter types. Most commonly, the site of embolization is to the heart. Point-of-care ultrasound is an easily accessible imaging modality that should be utilized when considering IVC filter complications. CASE REPORT: A 28-year-old woman with a history of metastatic sarcoma and IVC filter placement for deep venous thrombosis presented to the Emergency Department (ED) for chest pain...
March 6, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28279382/trials-of-imaging-use-in-the-emergency-department-for-acute-chest-pain
#9
REVIEW
Gilbert L Raff, Udo Hoffmann, James E Udelson
Over 8 million patients seek emergency department care for acute chest pain annually in the United States alone, and <5% have an acute coronary syndrome. In the absence of overt electrocardiographic or biomarker evidence, expensive and time-consuming diagnostic strategies are frequently required. Beginning in 2000, radionuclide myocardial perfusion, stress echocardiography, cardiac magnetic resonance imaging, and coronary computed tomographic angiography have become increasingly common in evaluating these patients...
March 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28268118/the-role-of-early-focused-cardiac-ultrasound-in-a-not-so-typical-presentation-of-takotsubo-cardiomyopathy-a-case-report
#10
Jithin G Varghese, Qurat-Ul-Ain Jelani, Stuart Zarich, Brooks Walsh
BACKGROUND: Focused cardiac ultrasound (FoCUS) can be extremely helpful in identifying unexpected diagnoses that can significantly alter treatment options. The diagnosis of Takotsubo cardiomyopathy (TCM) may be difficult to identify. CASE REPORT: We describe a 47-year-old woman who presented to the emergency department (ED) with atypical features of TCM. Her clinical features included being a premenopausal woman with mild chest pain with a lack of identifiable emotional or physical stressors or significant electrocardiographic changes...
March 3, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28262338/differences-in-presentation-management-and-outcomes-in-women-and-men-presenting-to-an-emergency-department-with-possible-cardiac-chest-pain
#11
Lorcan Ruane, Jaimi H Greenslade, William Parsonage, Tracey Hawkins, Christopher Hammett, Carolyn Sp Lam, Thomas Knowlman, Shaela Doig, Louise Cullen
BACKGROUND: Research suggests that female patients with acute coronary syndrome (ACS) experience delays in emergency department (ED) management and are less likely to receive guideline-based treatments and referrals for follow-up testing. Women are often found to have poorer clinical outcomes in comparison to men. This study aimed to assess current sex differences in the presentation, management and outcomes of patients with undifferentiated chest pain presenting to a tertiary ED. METHODS: Data were analysed from two prospective studies conducted at a single Australian site between 2007 and 2014...
February 17, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28261908/acute-coronary-syndrome-screening-and-diagnostic-practice-variation
#12
Maame Yaa A B Maya Yiadom, Xulei Liu, Conor M McWade, Dandan Liu, Alan B Storrow
BACKGROUND: In the absence of the existing acute coronary syndrome guidelines directing the clinical practice implementation of ED screening and diagnosis, there is variable screening and diagnostic clinical practice across ED facilities. This practice diversity may be warranted. Understanding the variability may identify opportunities for more consistent practice. METHODS: This is a cross-sectional clinical practice epidemiology study with the emergency department (ED) as the unit of analysis characterizing variability in the acute coronary syndrome (ACS) evaluation across 62 diverse EDs...
March 6, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28261896/identifying-low-risk-patients-for-early-discharge-from-emergency-department-without-using-subjective-descriptions-of-chest-pain-insights-from-providing-rapid-out-of-hospital-acute-cardiovascular-treatment-proact-3-and-4-trials
#13
Nariman Sepehrvand, Yinggan Zheng, Paul W Armstrong, Robert C Welsh, Justin A Ezekowitz
BACKGROUND: Several accelerated diagnostic protocols (ADP) have been developed to allow emergency department (ED) physicians to identify appropriate patients for safe early discharge after presentation with symptom of chest pain. Most ADPs require chest pain to be described and modify the algorithm based on the subjective chest pain characteristics. We investigated the performance of 3 established major ADPs simplified by eliminating the need for chest pain as a descriptor. METHODS: We pooled patients from PROACT-3 and 4 trials, in which patients presenting to emergency medical services (EMS) with chest pain or dyspnea were enrolled...
March 6, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28256404/panic-disorder-in-patients-presenting-to-the-emergency-department-with-chest-pain-prevalence-and-presenting-symptoms
#14
Jaimi H Greenslade, Tracey Hawkins, William Parsonage, Louise Cullen
BACKGROUND: Patients with panic disorder experience symptoms such as palpitations, chest pain, dizziness, and breathlessness. Consequently, they may attend the Emergency Department (ED) to be assessed for possible emergency medical conditions. Recognition of panic disorder within the ED is low. We sought to establish the prevalence of panic disorder in patients presenting to the for ED investigation of potential acute coronary syndrome. We also sought to characterise the cohort of patients with panic disorder in terms of presenting symptoms, risk factors, medical history and major adverse cardiac events (MACE)...
February 16, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28254102/auricular-acupuncture-analgesia-in-thoracic-trauma-a-case-report
#15
Georgios S Papadopoulos, Petros Tzimas, Antonia Liarmakopoulou, Anastasios M Petrou
We report a case of thoracic trauma (rib fractures with pneumothorax and pulmonary contusions) with severe chest pain leading to ineffective ventilation and oxygenation. The patient presented to our emergency department. The patient had chronic obstructive pulmonary disease and was completely unable to take deep breaths and clear secretions from his bronchial tree. After obtaining informed consent, we applied auricular acupuncture to ameliorate pain and hopefully improve his functional ability to cough and breathe deeply...
January 2017: Journal of Acupuncture and Meridian Studies
https://www.readbyqxmd.com/read/28246315/prospective-validation-of-a-clinical-decision-rule-to-identify-patients-presenting-to-the-emergency-department-with-chest-pain-who-can-safely-be-removed-from-cardiac-monitoring
#16
Shahbaz Syed, Mathieu Gatien, Jeffrey J Perry, Hina Chaudry, Soo-Min Kim, Kenneth Kwong, Muhammad Mukarram, Venkatesh Thiruganasambandamoorthy
BACKGROUND: Most patients with chest pain in the emergency department are assigned to cardiac monitoring for several hours, blocking access for patients in greater need. We sought to validate a previously derived decision rule for safe removal of patients from cardiac monitoring after initial evaluation in the emergency department. METHODS: We prospectively enrolled adults (age ≥ 18 yr) who presented with chest pain and were assigned to cardiac monitoring at 2 academic emergency departments over 18 months...
January 30, 2017: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
https://www.readbyqxmd.com/read/28238395/profound-hypotension-and-bradycardia-in-the-setting-of-synthetic-cannabinoid-intoxication-a-case-series
#17
David O Andonian, Shauna R Seaman, Elaine B Josephson
Cannabinoids are the most commonly used illegal substances in the world [1]. Synthetic Cannabinoids (SCB) are also known as "Spice", "K2", "Spike", "herbal incense", "Cloud 9", "Mojo" and many others are becoming a large public health concern due to their increasing use, unpredictable toxicity, and abuse potential [2]. The most common reported toxicities with SCB use based on studies using Texas Poison control record are tachycardia, agitation and irritability, drowsiness, hallucinations, delusions, hypertension, nausea, confusion, dizziness, vertigo, chest pain, acute kidney injury, seizures, heart attacks and both ischemic and hemorrhagic strokes [3]...
January 12, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28236543/diagnostic-and-prognostic-values-of-the-v-index-a-novel-ecg-marker-quantifying-spatial-heterogeneity-of-ventricular-repolarization-in-patients-with-symptoms-suggestive-of-non-st-elevation-myocardial-infarction
#18
Roger Abächerli, Raphael Twerenbold, Jasper Boeddinghaus, Thomas Nestelberger, Patrick Mächler, Roberto Sassi, Massimo W Rivolta, Ebadollah Kheirati Roonizi, Luca T Mainardi, Nikola Kozhuharov, Maria Rubini Giménez, Karin Wildi, Karin Grimm, Zaid Sabti, Petra Hillinger, Christian Puelacher, Ivo Strebel, Janosch Cupa, Patrick Badertscher, Isabelle Roux, Ramun Schmid, Remo Leber, Stefan Osswald, Christian Mueller, Tobias Reichlin
BACKGROUND: The V-index is an ECG marker quantifying spatial heterogeneity of ventricular repolarization. We prospectively assessed the diagnostic and prognostic values of the V-index in patients with suspected non-ST-elevation myocardial infarction (NSTEMI). METHODS: We prospectively enrolled 497 patients presenting with suspected NSTEMI to the emergency department (ED). Digital 12-lead ECGs of five-minute duration were recorded at presentation. The V-index was automatically calculated in a blinded fashion...
February 7, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28236513/remote-management-of-low-to-intermediate-risk-chest-pain-a-case-series
#19
Alexander Chiu, Kathleen Shumaker, Christopher Del Corral, Blessy George, Michael Kasper, Marie-Carmelle Elie, Preeti Jois, Daniel Dipsia, Adam Ash
We report a case series of three low to intermediate risk chest pain patients who presented to the emergency department and were managed as outpatients via the Cellular Outpatient Twelve-Lead Telemetry with Emergency Response (COTTER™). This technology allows for certain chest pain patients to be managed remotely via telemedicine while receiving care comparable to that which would be available in a hospital or chest pain observation unit.
February 16, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28228875/traumatic-nonanastomotic-axilloprofundal-ptfe-bypass-rupture-a-case-report
#20
Borna K Barth, Fabian Hässler, Oliver Graubitz
A 76-year-old male patient was admitted to our emergency department with painful swelling of the right lateral chest after a fall. Imaging revealed a hematoma, secondary to rupture of a synthetic axilloprofundal bypass. In an emergency surgical procedure, the spelled hematoma was evacuated and the graft legs were successfully ligated. The patient was discharged after an uneventful hospital stay. Traumatic bypass rupture because of blunt trauma is an exceedingly rare event; however, it must be taken into consideration in a patient with bypass surgery in his/her history...
March 2017: Radiology case reports
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