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Emergency Department Management

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https://www.readbyqxmd.com/read/27931533/care-transition-interventions-for-children-with-asthma-in-the-emergency-department
#1
REVIEW
Molly A Martin, Valerie G Press, Sharmilee M Nyenhuis, Jerry A Krishnan, Kim Erwin, Giselle Mosnaim, Helen Margellos-Anast, S Margaret Paik, Stacy Ignoffo, Michael McDermott
The emergency department (ED) is a critical point of identification and treatment for some of the most high-risk children with asthma. This review summarizes the evidence regarding care transition interventions originating in the ED for children with uncontrolled asthma, with a focus on care coordination and self-management education. Although many interventions on care transition for pediatric asthma have been tested, only a few were actually conducted in the ED setting. Most of these targeted both care coordination and self-management education but ultimately did not improve attendance at follow-up appointments with primary care providers, improve asthma control, or reduce health care utilization...
December 2016: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/27930967/epidemiology-and-diagnostic-and-therapeutic-management-of-febrile-seizures-in-the-italian-pediatric-emergency-departments-a-prospective-observational-study
#2
Giovanna Vitaliti, Emanuele Castagno, Fulvio Ricceri, Antonio Urbino, Alberto Verrotti Di Pianella, Riccardo Lubrano, Elisa Caramaschi, Maurizio Prota, Rita Maria Pulvirenti, Patrizia Ajovalasit, Giuseppe Signorile, Carla Navone, Maria Rosaria La Bianca, Alberto Villani, Giovanni Corsello, Raffaele Falsaperla
AIM: Febrile seizures (FS) involve 2-5% of the paediatric population, among which Complex FS (CFS) account for one third of accesses for FS in Emergency Departments (EDs). The aim of our study was to define the epidemiology, the clinical, diagnostic and therapeutic approach to FS and CFSs in the Italian EDs. METHODS: A multicenter prospective observational study was performed between April 2014 and March 2015. Patients between 1 and 60 months of age, randomly accessing to ED for ongoing FS or reported FS at home were included...
November 16, 2016: Epilepsy Research
https://www.readbyqxmd.com/read/27929691/association-between-pediatric-home-management-plan-of-care-compliance-and-asthma-readmission
#3
Ronen Zipkin, Sheree M Schrager, Eugene Nguyen, Mary Rose Mamey, Ingrid Banuelos, Susan Wu
OBJECTIVES: In 2007, The Joint Commission implemented three children's asthma care (CAC) measures to help improve the quality of care for patients admitted with asthma. Due to lack of consistent evidence showing a relationship between home management plan of care (HMPC) compliance and readmission rates, CAC-3 was retired in 2016. We aimed to understand the relationship between HMPC compliance and revisits to the hospital, and investigate which components of the HMPC, if any, were driving the effect...
December 8, 2016: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/27927820/headache-in-an-hiv-positive-patient-diagnostic-challenges-and-approach-to-treatment%C3%A2
#4
Andrew Creamer, Stefanos Ioannidis, Thomas Wilhelm, Tabitha Mahangu, Marc Lipman
Headaches are a common complaint in HIV positive patients attending emergency services. A thorough understanding of the differential diagnoses, initial investigations and empirical management of this presentation is essential for the assessing physician. We discuss a case of a patient with known advanced HIV infection presenting with headache to the emergency department. Given the range of possible diagnoses, broad-spectrum antimicrobial therapy was initially commenced. This was stopped when magnetic resonance imaging confirmed a diagnosis of venous sinus thrombosis...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27927258/a-case-of-tetanus-secondary-to-an-odontogenic-infection
#5
Majid Darraj, James Stone, Yoav Keynan, Kristjan Thompson, Carolyn Snider
Tetanus is a life-threatening clinical syndrome that commonly presents with muscular spasms, rigidity, and autonomic instability. It is considered rare in industrialized countries, and tetanus occurring secondary to dental abscesses, procedures, or infections has been infrequently reported. We describe the case of a patient inadequately immunized for tetanus, who presented to the emergency department with muscular spasms, rigidity, and autonomic instability in the setting of an odontogenic infection. A clinical diagnosis of tetanus was made and subsequently managed successfully...
December 8, 2016: CJEM
https://www.readbyqxmd.com/read/27927257/unusual-diagnosis-in-a-patient-with-minor-ankle-trauma
#6
Zoë Piggott, Donna Clark
We present the case of a 23 year-old male who sustained an anterior tibial artery pseudoaneurysm after an apparently innocuous soccer injury. The patient presented with sudden onset severe pain and swelling one week after the injury. The diagnosis was made using duplex ultrasound, and confirmed with CT angiography. Definitive management consisted of endovascular platinum microcoiling. One year later, the patient is asymptomatic and remains active. A review of the epidemiology, diagnosis, and treatment of arterial pseudoaneurysm is presented...
December 8, 2016: CJEM
https://www.readbyqxmd.com/read/27926663/the-impact-of-value-based-healthcare-for-inflammatory-bowel-diseases-on-healthcare-utilization-a-pilot-study
#7
Welmoed K van Deen, Arlen Spiro, A Burak Ozbay, Martha Skup, Adriana Centeno, Natalie E Duran, Precious N Lacey, Darius Jatulis, Eric Esrailian, Martijn G H van Oijen, Daniel W Hommes
BACKGROUND AND OBJECTIVES: Value-based healthcare (VBHC) is considered to be the solution that will improve quality and decrease costs in healthcare. Many hospitals are implementing programs on the basis of this strategy, but rigorous scientific reports are still lacking. In this pilot study, we present the first-year outcomes of a VBHC program for inflammatory bowel disease (IBD) management that focuses on highly coordinated care, task differentiation of providers, and continuous home monitoring...
December 6, 2016: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/27926614/clinical-coordination-in-accountable-care-organizations-a-qualitative-study
#8
Valerie A Lewis, Karen Schoenherr, Taressa Fraze, Aleen Cunningham
BACKGROUND: Accountable care organizations (ACOs) are becoming a common payment and delivery model. Despite widespread interest, little empirical research has examined what efforts or strategies ACOs are using to change care and reduce costs. Knowledge of ACOs' clinical efforts can provide important context for understanding ACO performance, particularly to distinguish arenas where ACOs have and have not attempted care transformation. PURPOSE: The aim of the study was to understand ACOs' efforts to change clinical care during the first 18 months of ACO contracts...
December 6, 2016: Health Care Management Review
https://www.readbyqxmd.com/read/27926537/lactate-arterial-and-venous-agreement-in-sepsis-a-prospective-observational-study
#9
Deepankar Datta, Julia Grahamslaw, Alasdair J Gray, Catriona Graham, Craig A Walker
BACKGROUND: Sepsis is a common condition in the emergency department (ED). Lactate measurement is an important part of management: arterial lactate (A-LACT) measurement is the gold standard. There is increasing use of peripheral venous lactate (PV-LACT); however, there is little research supporting the interchangeability of the two measures.If PV-LACT has good agreement with A-LACT, it would significantly reduce patient discomfort and the risks of arterial sampling for a large group of acutely unwell patients, while allowing faster and wider screening, with potential reduced costs to the healthcare system...
December 6, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/27925670/limited-abdominal-sonography-for-evaluation-of-children-with-right-lower-quadrant-pain
#10
Martha M Munden, Shannon Wai, Michael C DiStefano, Wei Zhang
OBJECTIVES: To determine whether a complete abdominal sonographic examination is necessary in the evaluation of children with right lower quadrant pain that is suspicious for appendicitis in the emergency department and whether performing a limited, more-focused study would miss clinically important disease. METHODS: With Institutional Review Board approval, a retrospective study was performed of 704 patients, from ages 5-19 years, presenting to the emergency department with right lower quadrant pain that was suspicious for appendicitis who underwent a complete abdominal sonographic examination...
November 30, 2016: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/27923754/successful-coil-embolization-of-pediatric-carotid-cavernous-fistula-due-to-ruptured-post-traumatic-giant-internal-carotid-artery-aneurysm
#11
Daisuke Wajima, Ichiro Nakagawa, Hun Soo Park, Shohei Yokoyama, Takeshi Wada, Kimihiko Kichikawa, Hiroyuki Nakase
BACKGROUND: The goal of the treatment of direct carotid cavernous fistula (CCF) is to occlude the arteriovenous shunt and to preserve the patency of the concerned internal carotid artery (ICA). However, for the ipsilateral post-traumatic fragile cerebrum, coil embolization plus parent artery occlusion for the high flow direct CCF would be better for the prevention of hyper-perfusion syndrome and the intracranial hemorrhage. We experienced such a case and managed it successfully. CASE DESCRIPTION: A 6-year-old boy was suffered from severe head trauma caused by being hit by a car...
December 3, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27923314/value-of-early-warning-scores-in-emergency-departments
#12
(no author information available yet)
Developed in the belief that early identification and intervention of deteriorating patients would reduce the number of deaths, early warning scores (EWS) have become a routine feature of work in UK emergency departments (EDs) and are becoming increasingly common in paediatric emergency care. They are popular with managers, commissioners and clinicians, yet the authors of this report state that there is little evidence of this reduction in the literature.
December 7, 2016: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/27923294/recognition-and-nursing-management-of-diabetes-in-children
#13
Polly Teuten, Sharon Holt, Sujata Edate, Siba Prosad Paul
Diabetes mellitus is a common condition in children, characterised by chronic hyperglycaemia resulting from an absolute insulin deficiency. It can present in various ways, and hospital admission may result from complications related to previously diagnosed diabetes, or from a new diagnosis. To raise awareness of the condition, Diabetes UK has launched the 4Ts campaign, which highlights the four most common symptoms of diabetes. This article discusses the different clinical presentations, diagnosis and management of children with diabetes, and includes two case studies to illustrate some of the challenges faced by emergency department nurses...
December 7, 2016: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/27923204/case-report-of-the-surgical-management-of-small-bowel-and-colonic-ischaemia-associated-with-anorexia-nervosa-binge-purge-subtype
#14
Ann T Foran, Cillian Clancy, Tom F Gorey
INTRODUCTION: Anorexia Nervosa affects up to 1% of the population and can present with binge/purge episodes. A paucity of literature exists regarding small bowel and colonic ischaemia relating to this common condition. We report our own experience and management of a patient with anorexia nervosa binge/purge subtype with small bowel and colon ischaemia and review existing cases in the literature. PRESENTATION OF CASE: A 32year old female self-presented to the emergency department complaining of abdominal pain, abdominal distension and vomiting on a background history of binge/purge subtype eating disorder, following consumption of a large amount of carbohydrates...
August 25, 2016: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/27921014/fireworks-related-injuries-in-iran-a-survey-following-the-2014-new-year-s-festival-in-tabriz
#15
Samad Shams Vahdati, Jamil Hemmate Gadim, Hossein Mazouchian
BACKGROUND: Iranian people celebrate the last Wednesday eve of the year as Chaharshanbe Suri and use explosives and firecrackers as part of this festival. OBJECTIVES: This study concerned fireworks injuries related to the Chaharshanbe Suri festival in Tabriz, a provincial capital in East Azerbaijan, Iran, to evaluate the epidemiology and provide data to prevent and manage these accidents. PATIENTS AND METHODS: This study was comprised of patients who were treated at the emergency department of Tabriz Sina hospital with burn injuries related to fireworks...
July 2016: Trauma Monthly
https://www.readbyqxmd.com/read/27920878/utilization-of-bedside-ultrasound-in-the-diagnosis-and-management-of-massive-pulmonary-embolism-a-case-report
#16
Osman Z Abbasi, Thanhnga T Doan, Sumit Duggal, Sanjeev U Nair, Shawn M Quinn
The prompt diagnosis and treatment of massive pulmonary embolism is a well-known challenge for physicians. We report a case of a 61-year-old hemodynamically unstable man who presented to the emergency department with complaints of acute dyspnea. After performing a focused history and physical, we used bedside ultrasound to diagnose significant right heart strain, which suggested massive bilateral pulmonary embolisms. This diagnosis was further supported by the visualization of deep venous thrombosis in the left lower extremity...
December 2016: Radiology case reports
https://www.readbyqxmd.com/read/27919874/diltiazem-versus-metoprolol-for-rate-control-in-atrial-fibrillation-with-rapid-ventricular-response-in-the-emergency-department
#17
Michelle C Hines, Brent N Reed, Vijay Ivaturi, Laura J Bontempo, Michael C Bond, Bryan D Hayes
PURPOSE: The impact of patient-specific factors on the choice of β-blocker versus calcium channel blocker therapy for rate control in emergency department (ED) patients treated for atrial fibrillation (AF) was investigated. METHODS: A retrospective cohort study was conducted to evaluate the influence of demographics, prior medication use, hemodynamic and clinical characteristics, and other variables on selection of first-line therapy for AF among patients admitted to the ED of an academic medical center over a 22-month period (October 2012-July 2014) who received i...
December 15, 2016: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/27919472/the-value-of-a-poison-control-center-in-preventing-unnecessary-emergency-department-visits-and-hospital-charges-a-multi-year-analysis
#18
Casey R Tak, Marty C Malheiro, Heather K W Bennett, Barbara I Crouch
OBJECTIVE: The purpose of this study is to determine the economic value of the Utah Poison Control Center (UPCC) by examining its contribution to the reduction of unnecessary emergency department (ED) visits and associated charges across multiple years. METHODS: A multi-year (2009-2014) analysis of cross-sectional data was performed. Callers were asked what they would do for a poison emergency if the UPCC was not available. Healthcare charges for ED visits averted were calculated according to insurance status using charges obtained from a statewide database...
November 22, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27919376/usability-evaluation-of-the-smart-application-for-youth-with-mtbi
#19
Judith W Dexheimer, Brad G Kurowski, Shilo H Anders, Nicole McClanahan, Shari L Wade, Lynn Babcock
OBJECTIVE: There is a dearth of evidence-based treatments available to address the significant morbidity associated with mild traumatic brain injury (mTBI). To address this gap, we designed a novel user-friendly, web-based application. We describe the preliminary evaluation of feasibility and usability of the application to promote recovery following mTBI in youth, the Self-Monitoring Activity-Restriction and Relaxation Treatment (SMART). SMART incorporates real-time recommendations for individualized symptom management and activity restriction along with training in cognitive-behavioral coping strategies...
January 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/27919374/the-m-health-revolution-exploring-perceived-benefits-of-whatsapp-use-in-clinical-practice
#20
Kurubaran Ganasegeran, Pukunan Renganathan, Abdul Rashid, Sami Abdo Radman Al-Dubai
BACKGROUND: The dawn of m-Health facilitates new horizons of professional communication through WhatsApp, allowing health professionals to interact fast and efficiently for effective patient management. This preliminary study aimed to investigate perceived benefits, if any, of WhatsApp use across general medical and emergency teams during clinical practice in Malaysia. METHODS: A cross-sectional study was conducted in a universal sample of 307 health professionals comprising of nurses, medical assistants, medical residents, medical officers and physicians across medical and casualty departments in a Malaysian public hospital...
January 2017: International Journal of Medical Informatics
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