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Emergency Department Management

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https://www.readbyqxmd.com/read/28929478/defining-a-risk-informed-framework-for-whole-of-government-lessons-learned-a-canadian-perspective
#1
Shaye K Friesen, Shelley Kelsey, J A Jim Legere
Lessons learned play an important role in emergency management (EM) and organizational agility. Virtually all aspects of EM can derive benefit from a lessons learned program. From major security events to exercises, exploiting and applying lessons learned and "best practices" is critical to organizational resilience and adaptiveness. A robust lessons learned process and methodology provides an evidence base with which to inform decisions, guide plans, strengthen mitigation strategies, and assist in developing tools for operations...
July 2017: Journal of Emergency Management: JEM
https://www.readbyqxmd.com/read/28929477/superstorm-sandy-emergency-management-staff-perceptions-of-impact-and-recommendations-for-future-preparedness-new-york-state
#2
Adam Yanson, Asante Shipp Hilts, Stephanie Mack, Millicent Eidson, Trang Nguyen, Guthrie Birkhead
OBJECTIVE: This study collected and summarized feedback from staff at the New York State (NYS) Office of Emergency Management (OEM) and three county OEMs within NYS to understand lessons learned from the 2012 Superstorm Sandy. DESIGN: Cross-sectional qualitative and quantitative analysis. SUBJECTS, PARTICIPANTS: One staff person from each identified critical role from the state and county OEMs who were still employed in the roles identified...
July 2017: Journal of Emergency Management: JEM
https://www.readbyqxmd.com/read/28927973/violence-towards-emergency-nurses-a-narrative-review-of-theories-and-frameworks
#3
REVIEW
Nicola Ramacciati, Andrea Ceccagnoli, Beniamino Addey, Enrico Lumini, Laura Rasero
INTRODUCTION: Workplace Violence in the health environment is a growing issue worldwide. Emergency department have been identified asa high-risk setting for Workplace Violence and emergency nurses are most exposed to this phenomenon. To address workplace violence in the ED effectively, it is critical to understand frameworks established in the literature to assist in development of appropriate interventions and corrective measures. An overview of available theories of violence towards emergency nurses in the literature is presented herein in the format of a narrative review...
September 16, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28927481/a-system-wide-solution-to-antidote-stocking-in-emergency-departments-the-nova-scotia-antidote-program
#4
Nancy G Murphy, D Ruth Bona, Theresa A Hurley
OBJECTIVE: Inadequate stocking of essential antidotes in hospitals is an internationally documented problem. A concrete and sustainable system-wide solution for easy access to antidotes in emergency departments (EDs) was developed and implemented in Nova Scotia, Canada. METHODS: Antidote stocking guidelines and a systemwide antidote management strategy were established. A standardized collection of antidotes housed in highly visible containers in provincial EDs was implemented for timely access...
September 20, 2017: CJEM
https://www.readbyqxmd.com/read/28927439/barriers-and-facilitators-towards-implementing-the-sepsis-six-care-bundle-bliss-1-a-mixed-methods-investigation-using-the-theoretical-domains-framework
#5
Neil Roberts, Guy Hooper, Fabiana Lorencatto, Wendell Storr, Michael Spivey
BACKGROUND: The 'Sepsis 6', a care bundle of basic, but vital, measures (e.g. intravenous fluid, antibiotics) has been implemented to improve sepsis treatment. However, uptake has been variable. Tools from behavioral sciences, such as the Theoretical Domains Framework (TDF) may be used to understand and address such implementation issues. This study used a behavioral science approach to identify barriers and facilitators towards Sepsis Six implementation at a case study hospital. METHODS: Semi-structured interviews based on the TDF were conducted with a sample group of consultants, junior doctors and nurses from Emergency Department, Medical and Surgical Admissions, to explore barriers/facilitators to Sepsis Six performance...
September 19, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28926506/family-perspectives-on-visiting-the-pediatric-emergency-department-for-migraine-a-qualitative-study
#6
Serena Laura Orr, Liam OʼSullivan, Roger Zemek, Natalie M Ward, Hugh J McMillan
OBJECTIVE: The aim of this study was to explore the perspectives of families regarding their expectations and experience of visiting the emergency department (ED) for migraine. METHODS: This was a qualitative study involving the families of 25 patients aged 10 to 18 years receiving ED care for acute migraine. Following their visit, independent semistructured telephone interviews were conducted with both the patient and parent or guardian. Questions were designed to explore factors pertaining to the family's perspective regarding their visit to the ED and expectations for the ED visit...
September 18, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28926505/do-all-clavicle-fractures-in-children-need-to-be-managed-by-orthopedic-surgeons
#7
John Adamich, Andrew Howard, Mark Camp
OBJECTIVES: Although many uncomplicated pediatric fractures do not require routine long-term follow-up with an orthopedic surgeon, practitioners with limited experience dealing with pediatric fractures will often defer to a strategy of frequent clinical and radiographic follow-up. Development of an evidence-based clinical care pathway can help unnecessary radiation exposure to this patient population and reduce costs to patient families and the health care system. METHODS: A retrospective analysis including patients who presented to the Hospital for Sick Children (SickKids) for management of clavicle fractures was performed...
September 18, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28925655/pleuritic-chest-pain-sorting-through-the-differential-diagnosis
#8
Brian V Reamy, Pamela M Williams, Michael Ryan Odom
Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Pulmonary embolism is the most common serious cause, found in 5% to 21% of patients who present to an emergency department with pleuritic chest pain. A validated clinical decision rule for pulmonary embolism should be employed to guide the use of additional tests such as d-dimer assays, ventilation-perfusion scans, or computed tomography angiography. Myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax are other serious causes that should be ruled out using history and physical examination, electrocardiography, troponin assays, and chest radiography before another diagnosis is made...
September 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/28925416/extracting-autism-spectrum-disorder-data-from-the-electronic-health-record
#9
Ruth A Bush, Cynthia D Connelly, Alexa Pérez, Halsey Barlow, George J Chiang
BACKGROUND: Little is known about the health care utilization patterns of individuals with pediatric autism spectrum disorder (ASD). OBJECTIVES: Electronic health record (EHR) data provide an opportunity to study medical utilization and track outcomes among children with ASD.  Methods: Using a pediatric, tertiary, academic hospital's Epic EHR, search queries were built to identify individuals aged 2-18 with International Classification of Diseases, Ninth Revision (ICD-9) codes, 299...
July 19, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28924623/the-effectiveness-of-pharmacist-provided-telephonic-medication-therapy-management-on-emergency-department-utilization-in-home-health-patients
#10
Stephanie A Gernant, Margie E Snyder, Heather Jaynes, Jason M Sutherland, Alan J Zillich
BACKGROUND: Preventable emergency department (ED) use may be targeted with interventions for improving the medication use process, as medication misadventures and non-adherence frequently cause preventable ED utilization. One intervention that could prevent ED visits is Medication Therapy Management (MTM). OBJECTIVE: To evaluate the effectiveness of a telephonic medication therapy management (MTM) service on reducing emergency department utilization within a Medicare insured home health population...
October 1, 2016: Journal of Pharmacy Technology: JPT: Official Publication of the Association of Pharmacy Technicians
https://www.readbyqxmd.com/read/28924614/porcelain-gallbladder-often-an-overlooked-entity
#11
Sohail Iqbal, Sarfraz Ahmad, Usman Saeed, Mohammed Al-Dabbagh
Background  Porcelain gallbladder (GB) is a rare but potentially premalignant condition with minimal symptoms. Accident and Emergency (A&E) departments often tend to investigate abdominal pain through plain radiographs, which are occasionally reported by radiologists, thereby leaving behind few uncommon conditions, such as porcelain gallbladder unreported. Objectives  We present three cases of porcelain GB in which initial diagnosis was not considered due to the presence of various other calcifications in the upper abdomen...
October 2017: Surg J (N Y)
https://www.readbyqxmd.com/read/28924282/overcrowding-and-possible-solutions-for-a-busy-paediatric-emergency-department
#12
Muhammad Irfan Habib, Khalid Mehmood Khan
OBJECTIVE: To quantify the extent of emergency department overcrowding in a tertiary care hospital and to identify possible solutions. METHODS: This retrospective study was conducted at the National Institute of Child Health, Karachi, and comprised data of all patients presenting to the emergency department from November 2014 to January 2015. Data was collected through the health management information system which generates daily report of patients. Patients who stayed at the emergency department for 4 or more hours were included...
September 2017: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/28923845/high-sensitivity-cardiac-troponin-i-as-a-gatekeeper-for-coronary-computed-tomography-angiography-and-stress-testing-in-patients-with-acute-chest-pain
#13
Maros Ferencik, Thomas Mayrhofer, Michael T Lu, Pamela K Woodard, Quynh A Truong, W Frank Peacock, Fabian Bamberg, Benjamin C Sun, Jerome L Fleg, John T Nagurney, James E Udelson, Wolfgang Koenig, James L Januzzi, Udo Hoffmann
BACKGROUND: Most patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) undergo noninvasive cardiac testing with a low diagnostic yield. We determined whether a combination of high-sensitivity cardiac troponin I (hs-cTnI) and cardiovascular risk factors might improve selection of patients for cardiac testing. METHODS: We included patients from the Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography (ROMICAT) I and II trials who presented to the ED with acute chest pain and were referred for cardiac testing...
September 18, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28923679/inguinal-hernia-containing-urinary-bladder-a-case-report
#14
Milena Taskovska, Jurij Janež
INTRODUCTION: Inguinal bladder hernia is rare condition found in about 1-5% of inguinal hernias. The condition is usually diagnosed intraoperatively. Patients rarely have symptoms regarding urinary tract. The best management is surgical, open surgical technique is preferred over laparoscopic. Possible urinary tract damage during surgery should be recognized and resolved. CASE PRESENTATION: The following paper presents case of inguinal bladder hernia in 82-year old Caucasian male...
September 5, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28923678/a-case-report-on-gastric-volvulus-of-a-17-years-old-boy-from-bangladesh
#15
M Tasdik Hasan, S M Tajdit Rahman, Hasan M Shihab, Hassan Rushekh Mahmood, Tanni Chowdhury, Quamrul Akhtar Sanju
INTRODUCTION: Gastric volvulus is a rare and true surgical emergency which is life threatening if not recognized and treated quickly. There have been approximately 300 reported cases globally till now. This condition most often occurs during 5th decade of life but there are over 100 reported pediatric cases also. This following rare incidence was such a case of a young patient in Bangladesh. It was the first case of gastric volvulus managed by the surgery department of the concerned hospital...
September 7, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28923103/moderate-sensitivity-and-high-specificity-of-emergency-department-administrative-data-for-transient-ischemic-attacks
#16
Amy Y X Yu, Hude Quan, Andrew McRae, Gabrielle O Wagner, Michael D Hill, Shelagh B Coutts
BACKGROUND: Validation of administrative data case definitions is key for accurate passive surveillance of disease. Transient ischemic attack (TIA) is a condition primarily managed in the emergency department. However, prior validation studies have focused on data after inpatient hospitalization. We aimed to determine the validity of the Canadian 10th International Classification of Diseases (ICD-10-CA) codes for TIA in the national ambulatory administrative database. METHODS: We performed a diagnostic accuracy study of four ICD-10-CA case definition algorithms for TIA in the emergency department setting...
September 18, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28923097/impact-of-perioperative-nutritional-status-on-the-outcome-of-abdominal-surgery-in-a-sub-saharan-africa-setting
#17
Christian Gael Mambou Tebou, Mazou N Temgoua, Agnès Esiene, Blondel Oumarou Nana, Jean Jacques Noubiap, Eugène Sobngwi
BACKGROUND: Malnutrition is a clinical condition of multifactorial etiologies and it is associated with several adverse outcomes. In high-income countries, malnutrition has been described as a determinant of delayed wound healing, surgical site infections and mortality in the postoperative period. There is limited information available regarding the outcome of surgery in malnourished patients in sub-Saharan Africa. METHODS: A cross-sectional analytic study was carried out between March and August 2014 in the visceral surgery and the emergency departments of the Yaounde Central Hospital in Cameroon...
September 18, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28921763/implementation-and-preliminary-clinical-outcomes-of-a-pharmacist-managed-venous-thromboembolism-clinic-for-patients-treated-with-rivaroxaban-post-emergency-department-discharge
#18
Baely M DiRenzo, Daren M Beam, Jeffrey A Kline, Karishma S Deodhar, Christina M Davis, Zachary A Weber, Todd A Walroth
OBJECTIVE: To describe the implementation, work flow, and differences in outcomes between a pharmacist-managed clinic for the outpatient treatment of venous thromboembolism (VTE) using rivaroxaban versus care by a primary care provider. INTERVENTIONS: Patients in the studied health system that are diagnosed with low-risk VTE in the emergency department are often discharged without hospital admission. These patients are treated with rivaroxban and follow up either in a pharmacist-managed VTE clinic or with their primary care provider...
September 16, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28921622/national-survey-on-managing-minor-childhood-traumatic-head-injuries-in-the-netherlands-shows-low-guideline-adherence-and-large-inter-hospital-variations
#19
Nicky Niele, Lonneke Willemars, Marlies van Houten, Frans B Plötz
More than 12,000 children are seen in Dutch emergency departments with a mild traumatic head injury (MTHI) every year. In The Netherlands, the paediatric MTHI guidelines are primarily based on the Pediatric Emergency Care Applied Research Network study (1). The guidelines define several criteria, based on the patient's age, to help clinicians to decide whether they need to perform a computed tomography (CT) scan (2). This national study determined the adherence to the guidelines and the reasons why clinicians deviated from them...
September 16, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28920564/intentional-overdose-of-the-novel-anti-epileptic-drug-eslicarbazepine-presenting-with-recurrent-seizures-and-ventricular-dysrhythmias
#20
Jesse Thompson, James D Powell, Daniel H Ovakim
Eslicarbazepine is a novel anti-epileptic agent indicated for the treatment of partial-onset seizures. We present the case of an 18 year old female that presented to the Emergency Department four hours after a reported intentional ingestion of an estimated 5600 mg of eslicarbazepine. Although initially hemodynamically stable and neurologically normal, shortly after arrival she developed confusion, rigidity and clonus, followed by recurrent seizures, hypoxemia and cardiac arrest which responded to cardiopulmonary resuscitation and wide complex tachycardia requiring defibrillation...
September 18, 2017: CJEM
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