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Emergency Department Management

Ramesh Kumar, Frederic W B Deleyiannis, Corbett Wilkinson, Brent R O'Neill
OBJECTIVE The authors' goals in this study were to describe a series of dog attacks on children that required neurosurgical consultation and to better understand the pattern of injuries inflicted, the circumstances that place children at risk for attack, and the dog breeds involved. In addition, the authors review the surgical and medical management of these patients. METHODS The authors performed a retrospective review of all children requiring neurosurgical consultation for dog bite at a regional Level 1 pediatric trauma center over a 15-year period...
October 21, 2016: Journal of Neurosurgery. Pediatrics
Li Liu, Wanjun Chen, Xiaoye Lu, Keji Zhang, Changqing Zhu
BACKGROUND: Pyogenic liver abscesses have become common in emergency departments (EDs) in recent years in Shanghai, China due to a variety of risk factors contributory to the disease. OBJECTIVE: To review our experience in managing pyogenic liver abscesses to aid in the current management of this complex condition. METHODS: This retrospective study was conducted to collect and analyze information from adult patients diagnosed with liver hepatic abscesses who were admitted to Ren Ji Hospital during the period from January 1, 2010 to December 31, 2015...
October 17, 2016: Journal of Emergency Medicine
Benjamin White, Rachel Rosovsky, Blair Alden Parry, Christopher Kabrhel
Pulmonary embolism (PE) and venous thromboembolism (VTE) are common diagnoses in the emergency department (ED), with significant potential morbidity and mortality. As a result, historically nearly all patients with PE have been admitted to the hospital for observation and treatment. In recent years, the ability to rapidly and accurately risk stratify patients with VTE according to their risk of short-term clinical deterioration has supported outpatient treatment, and non-vitamin K antagonist oral anticoagulants (NOACs) have further facilitated this approach...
October 20, 2016: Seminars in Thrombosis and Hemostasis
J de Gelder, J A Lucke, B de Groot, A J Fogteloo, S Anten, K Mesri, E W Steyerberg, C Heringhaus, G J Blauw, S P Mooijaart
BACKGROUND: Older patients experience high rates of adverse outcomes after an emergency department (ED) visit. Early identification of those at high risk could guide preventive interventions and tailored treatment decisions, but available models perform poorly in discriminating those at highest risk. The present study aims to develop and validate a prediction model for functional decline and mortality in older patients presenting to the ED. METHODS: A prospective follow-up study in patients aged ≥ 70, attending the EDs of the LUMC, the Netherlands (derivation) and Alrijne Hospital, the Netherlands (validation) was conducted...
October 2016: Netherlands Journal of Medicine
Afsin Emre Kayipmaz, Orcun Ciftci, Cemil Kavalci, Emir Karacaglar, Haldun Muderrisoglu
BACKGROUND: This study aimed to explore the ST segment elevation myocardial infarction (STEMI) management practices of emergency medicine specialists working in various healthcare institutions of seven different geographical regions of Turkey, and to examine the characteristics of STEMI presentation and patient admissions in these regions. METHODS: We included 225 emergency medicine specialists working in all geographical regions of Turkey. We e-mailed them a 20-item questionnaire comprising questions related to their STEMI management practices and characteristics of STEMI presentation and patient admissions...
2016: PloS One
I-Shiang Tzeng, Su-Hsun Liu, Kuan-Fu Chen, Chin-Chieh Wu, Jih-Chang Chen
To reduce patient boarding time at the emergency department (ED) and to improve the overall quality of the emergent care system in Taiwan, the Minister of Health and Welfare of Taiwan (MOHW) piloted the Grading Responsible Hospitals for Acute Care (GRHAC) audit program in 2007-2009.The aim of the study was to evaluate the impact of the GRHAC audit program on the identification and management of acute myocardial infarction (AMI)-associated ED visits by describing and comparing the incidence of AMI-associated ED visits before (2003-2007), during (2007-2009), and after (2009-2012) the initial audit program implementation...
October 2016: Medicine (Baltimore)
V R Badhwar, S Ganapathy, P P Prabhudesai, N K Tulara, A Y Varaiya, D Vyas
In community and family practice, infections are a common OPD presentation. In the management of common bacterial infections seen in community especially RTI, UTI, SSTI; cefuroxime a second generation cephalosporin with a broad spectrum of activity can be used for empirical treatment. To know current place of cefuroxime in the management of infections, physicians, surgeons, microbiologist, chest physician, gynecologist and pediatrician came together to discuss and debate their experience with cefuroxime and its place in today's world...
July 2016: Journal of the Association of Physicians of India
Karen A Croteau
Nursing is a physically active profession; however, nurses and nursing support staff may limit their physical activity (PA) on non-workdays. The purpose of this pilot study was to examine the effects of a 12-week pedometer-based PA intervention on daily steps of hospital nursing and support staff from two departments, emergency (ED) and oncology (ONC). The 12-week minimal-contact, self-managed intervention was designed to increase total and non-workday PA. Twenty participants with an average age of 47.6 ± 7...
October 10, 2016: Workplace Health & Safety
Louise Dunphy, Prashanth Shetty, Rabinder Randhawa, Kharil Amir Rani, Yaw Duodu
A 39-year-old man, born in India but resident in the UK for 10 years, was travelling in America when he became feverish with an altered mentation. He reported a 10-day history of fever, photophobia, headache and fatigue. His medical history included hypothyroidism and migraine. He was a non-smoker, did not consume alcohol and denied a history of drug use. He was transferred to the emergency department. Laboratory investigations confirmed hyponatraemia (sodium 128 mmol/L). A chest radiograph confirmed no focal consolidation...
October 7, 2016: BMJ Case Reports
J Pakpoor, D Saylor, I Izbudak, L Liu, E M Mowry, D M Yousem
BACKGROUND AND PURPOSE: The increasing use of the emergency department MR imaging scanner at our institution raises questions about its added value to certain patient groups. We hypothesized that the use of emergency department MR imaging for identifying active demyelination in MS patients presenting with new neurologic symptoms would be of low yield. MATERIALS AND METHODS: Electronic medical records were reviewed for patients with MS who had emergency department MR imaging scans for a suspected MS exacerbation between March 1, 2014, and March 1, 2016...
October 6, 2016: AJNR. American Journal of Neuroradiology
Jeremy D Brown, Scott Chapman, Patricia E Ferguson
OBJECTIVE: The objective of the present study is to determine whether a predictive rule could safely reduce the number of negative blood cultures collected in an Australian ED and to assess the clinical impact of positive results from blood cultures taken in the ED. METHODS: All positive blood cultures taken in the ED at a single facility were retrospectively identified for the calendar year 2012. Clinically significant bacteraemia episodes were assessed against a predictive rule using major and minor clinical and laboratory criteria gathered from medical records and pathology databases, and compared with a randomly generated sample of ED patient episode with negative blood cultures...
October 18, 2016: Emergency Medicine Australasia: EMA
Sandy Middleton, Chris Levi, Simeon Dale, N Wah Cheung, Elizabeth McInnes, Julie Considine, Catherine D'Este, Dominique A Cadilhac, Jeremy Grimshaw, Richard Gerraty, Louise Craig, Verena Schadewaldt, Patrick McElduff, Mark Fitzgerald, Clare Quinn, Greg Cadigan, Sonia Denisenko, Mark Longworth, Jeanette Ward
BACKGROUND: Internationally recognised evidence-based guidelines recommend appropriate triage of patients with stroke in emergency departments (EDs), administration of tissue plasminogen activator (tPA), and proactive management of fever, hyperglycaemia and swallowing before prompt transfer to a stroke unit to maximise outcomes. We aim to evaluate the effectiveness in EDs of a theory-informed, nurse-initiated, intervention to improve multidisciplinary triage, treatment and transfer (T(3)) of patients with acute stroke to improve 90-day death and dependency...
October 18, 2016: Implementation Science: IS
Rebecca DeVries, David Kriebel, Susan Sama
BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) contribute greatly to increased morbidity, mortality and diminished quality of life. Recent studies report moderately strong positive associations between exposures to several air pollutants and COPD-related emergency department (ED) visits and hospital admissions (HA). Studies that use clinically defined exacerbations rather than counting ED visits and HA may be more sensitive to environmental triggers like air pollution, but very few such studies exist...
October 18, 2016: Environmental Health: a Global Access Science Source
Fei Hu, Jiayan Zhang, Shupeng Shi, Zhang Zhou
BACKGROUND: Febrile illness in young children usually indicates an underlying infection and is a cause of concern for parents and carers. It is very important that healthcare professionals know how to recognize fever, assess children with fever, treat children with fever and role of nurses and parents. This paper outlines a best practice implementation project on the management of fever in children in an emergency department. OBJECTIVES: To audit current practice of fever management for children in an emergency department and to implement strategies to standardize pediatric fever management based on evidence-based practice guidelines...
September 2016: JBI Database of Systematic Reviews and Implementation Reports
Joshua M Abzug, Karan Dua, Andrea Sesko Bauer, Roger Cornwall, Theresa O Wyrick
Phalangeal fractures are the most common type of hand fracture that occurs in the pediatric population and account for the second highest number of emergency department visits for fractures in the United States. The incidence of phalangeal fractures is the highest in children aged 10 to 14 years, which coincides with the time that most children begin playing contact sports. Younger children are more likely to sustain a phalangeal fracture in the home setting as a result of crush and laceration injuries. Salter-Harris type II fractures of the proximal phalanx are the most common type of finger fracture...
November 2016: Journal of the American Academy of Orthopaedic Surgeons
John W Pickering, Jaimi H Greenslade, Louise Cullen, Dylan Flaws, William Parsonage, Sally Aldous, Peter George, Andrew Worster, Peter A Kavsak, Martin P Than
BACKGROUND: -The European Society of Cardiology (ESC) new guidelines to rule-in and rule-out acute myocardial infarction (AMI) in the emergency department (ED) include a rapid assessment algorithm based on high-sensitivity cardiac troponin and sampling at zero and one hour. ED physicians require very high sensitivity to confidently rule-out AMI, while cardiologists aim to minimise false positive results. METHODS: -High-sensitivity troponin I (hs-cTnI) and T (hs-cTnT) assays were used to measure troponin concentrations in patients presenting with chest-pain symptoms and being investigated for possible acute coronary syndrome at hospitals in New Zealand, Australia and Canada...
October 17, 2016: Circulation
Larisa M Strawbridge, Jennifer T Lloyd, Ann Meadow, Gerald F Riley, Benjamin L Howell
BACKGROUND: Diabetes is highly prevalent among Medicare beneficiaries, resulting in costly health care utilization. Strategies to improve health outcomes, such as disease self-management, could help reduce the increasing burden of diabetes. OBJECTIVES: Short-term benefits of diabetes self-management training (DSMT) are established; however, longer-term impacts among Medicare beneficiaries are unknown. RESEARCH DESIGN: Claims-based observational study with 1-year follow-up beginning 6 months after diabetes diagnosis...
October 6, 2016: Medical Care
Tommy Y Kim, Kristin Ratnayake
Minor cervical spine injury is a common cause of pediatric emergency department visits. We present a case of a 10-year-old boy with transient paresthesia after minor cervical trauma found to have a rare cervical spine abnormality requiring surgical fusion. We present and discuss the management options for os odontoideum.
October 8, 2016: Pediatric Emergency Care
Adam J Singer, Henry C Thode, W Frank Peacock
OBJECTIVE: Introduction of target specific anticoagulants and recent guidelines encourage outpatient management of low risk patients with venous thromboembolism. We describe hospital admission rates over time for patients presenting to US emergency departments (EDs) with deep vein thrombosis (DVT) and pulmonary embolism (PE) and estimate the proportion of low-risk PE patients who could potentially be managed as outpatients. METHODS: We performed a structured analysis of the National Hospital Ambulatory Medical Care Survey (a nationally representative weighted sampling of US ED visits) database for the years 2006-2010 including all adult patients with a primary diagnosis of DVT or PE...
September 2016: Clin Exp Emerg Med
Joon Woo Lee, Chan Ik Park, Hyung Il Kim, Oh Hyun Kim, Kyoung Chul Cha, Hyun Kim, Kang Hyun Lee, Sung Oh Hwang, Yong Sung Cha
OBJECTIVE: When managing patients with acute meningitis in an emergency department (ED), early diagnosis of the type of infection (bacterial or viral) considerably affects the clinical course and treatment because of the high mortality and morbidity associated with bacterial meningitis (BM). The serum delta neutrophil index (DNI), a new inflammatory marker, reflects the fraction of circulating immature granulocytes and is elevated in cases of bacterial infection. The objective of this study was to evaluate whether serum DNI can be used to differentiate between BM and viral meningitis (VM) in the ED...
June 2016: Clin Exp Emerg Med
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