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Emergency Department Management

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https://www.readbyqxmd.com/read/29778034/early-discharge-of-patients-with-pulmonary-embolism-in-daily-clinical-practice-a-prospective-observational-study-comparing-clinical-gestalt-and-clinical-rules
#1
Simone Vanni, Cecilia Becattini, Peiman Nazerian, Carlo Bova, Valerio Teodoro Stefanone, Ludovica Anna Cimini, Gabriele Viviani, Cosimo Caviglioli, Michela Sanna, Giuseppe Pepe, Stefano Grifoni
OBJECTIVES: To estimate the efficiency and safety of clinicians' gestalt in the identification of patients with pulmonary embolism (PE) candidates for early discharge and to compare the efficiency and safety of clinical gestalt with that of the Pulmonary Embolism Severity Index (PESI), the simplified PESI (sPESI) and the Hestia criteria (HC). METHODS: Consecutive adult patients presenting to the emergency department of four Italian hospitals with confirmed diagnosis of PE were included...
May 8, 2018: Thrombosis Research
https://www.readbyqxmd.com/read/29777436/fatigue-related-risk-management-in-the-emergency-department-a-focus-group-study
#2
Pierre Bérastégui, Mathieu Jaspar, Alexandre Ghuysen, Anne-Sophie Nyssen
Fatigue has major implications on both patient safety and healthcare practitioner's well-being. Traditionally, two approaches can be used to reduce fatigue-related risk: reducing the likelihood of a fatigued operator working (i.e. fatigue reduction), or reducing the likelihood that a fatigued operator will make an error (i.e. fatigue proofing). Recent progress mainly focussed on fatigue reduction strategies such as reducing work hours. Yet it has to be recognized that such approach has not wholly overcome the experience of fatigue...
May 18, 2018: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29776871/patients-experiences-of-pain-have-an-impact-on-their-pain-management-attitudes-and-strategies
#3
Eva Angelini, Helle Wijk, Helena Brisby, Adad Baranto
Postoperative pain remains undermanaged in orthopedic surgery. To identify areas of improvement for future structural changes in pain management, patients' experiences of pain and pain management when undergoing elective lumbar spine surgery were explored, using a qualitative method with focus group interviews. The study setting was an orthopedic spine surgery department at a University Hospital in Sweden. This study consisted of two focus group interviews with patients (n = 6/group, a total of 12 patients) who had undergone lumbar spine surgery 4 days to 5 weeks prior to the focus group interviews...
May 15, 2018: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/29775090/evaluation-of-management-and-guideline-adherence-in-children-with-mild-traumatic-brain-injury
#4
Merel C Broers, Jikke-Mien F Niermeijer, Irene A W Kotsopoulos, Hester F Lingsma, Jos F M Bruinenberg, Coriene E Catsman-Berrevoets
AIM: To evaluate the management and guideline adherence in children with mild traumatic brain injury (MTBI) in emergency departments (ED) in the Netherlands. METHODS: A multicentre cohort study was conducted, including children younger than 18 years with MTBI who presented within 24 hours after trauma in the ED of hospitals in the southwest region of the Netherlands, in 2014. Primary outcome measures for management were percentages of performed computed tomography (CT) scans and hospital admissions...
May 18, 2018: Brain Injury: [BI]
https://www.readbyqxmd.com/read/29774760/safety-of-nonsteroidal-anti-inflammatory-drugs-in-copperhead-snakebite-patients
#5
Hoang X Pham, Michael E Mullins
INTRODUCTION: Current management guidelines for pit viper envenomations recommend against the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control due to concern for platelet dysfunction and resulting coagulopathy. However, prior research suggests that copperhead snakes generally do not cause coagulopathy and they are responsible for most of the venomous snakebites in the USA. Thus, we compared the occurrences of clinically apparent bleeding and most abnormal laboratory values of coagulation between copperhead envenomation patients who received NSAIDs and those who did not...
May 18, 2018: Clinical Toxicology
https://www.readbyqxmd.com/read/29773453/a-structured-bowel-management-program-for-patients-with-severe-functional-constipation-can-help-decrease-emergency-department-visits-hospital-admissions-and-healthcare-costs
#6
Carlos A Reck-Burneo, Alejandra Vilanova-Sanchez, Alessandra C Gasior, Alexander J M Dingemans, Victoria A Lane, Robert Dyckes, Onnalisa Nash, Laura Weaver, Tassiana Maloof, Richard J Wood, Sarah Zobell, Michael D Rollins, Marc A Levitt
BACKGROUND: Published health-care costs related to constipation in children in the USA are estimated at $3.9 billion/year. We sought to assess the effect of a bowel management program (BMP) on health-care utilization and costs. METHODS: At two collaborating centers, BMP involves an outpatient week during which a treatment plan is implemented and objective assessment of stool burden is performed with daily radiography. We reviewed all patients with severe functional constipation who participated in the program from March 2011 to June 2015 in center 1 and from April 2014 to April 2016 in center 2...
March 24, 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29773251/-abcde-a-new-approach-to-patient-management-in-emergency-departments
#7
Frédéric Lodier
The ABCDE method constitutes an effective method of patient management in an emergency department. It is structured, systematic and universal. Many patients are able to benefit from it, in traumatology as well as in other sectors. It requires specific training.
May 2018: Soins; la Revue de Référence Infirmière
https://www.readbyqxmd.com/read/29773248/-characteristics-of-patient-management-in-emergency-departments
#8
Bénédicte Boisguérin, Fabien Toutlemonde, Albert Vuagnat
A national survey carried out in France in June 2013 studied for the first time all emergency department attendances over a 24-hour period. It enables patients' pathways through the emergency department to be described in detail, from their conditions of arrival through to the follow-up care downstream of their attendance.
May 2018: Soins; la Revue de Référence Infirmière
https://www.readbyqxmd.com/read/29772885/geographical-distribution-and-spatio-temporal-patterns-of-hospitalization-due-to-dengue-infection-at-a-leading-specialist-hospital-in-malaysia
#9
Gary K K Low, Panayoti Papapreponis, Ridzuan M Isa, Seng Chiew Gan, Hui Yee Chee, Kian Keong Te, Nadia M Hatta
Increasing numbers of dengue infection worldwide have led to a rise in deaths due to complications caused by this disease. We present here a cross-sectional study of dengue patients who attended the Emergency and Trauma Department of Ampang Hospital, one of Malaysia's leading specialist hospitals. The objective was to search for potential clustering of severe dengue, in space and/or time, among the annual admissions with the secondary objective to describe the spatio-temporal pattern of all dengue cases admitted to this hospital...
May 7, 2018: Geospatial Health
https://www.readbyqxmd.com/read/29771484/management-of-multiply-injured-pediatric-trauma-patients-in-the-emergency-department
#10
Andria Tatem, Rupa Kapoor
Management of the child with multiple traumatic injuries can be challenging, and important injuries may not be readily recognized. Early recognition of serious injuries, initiation of appropriate diagnostic studies, and rapid stabilization of injuries are key to decreasing morbidity and mortality in the multiply injured pediatric trauma patient. The differential diagnosis for these patients is wide, and treatment is targeted to the specific injuries. In this issue, a systematic approach to the multiply injured pediatric patient will be reviewed, with specific attention to commonly missed injuries and those injuries that may cause significant morbidity or mortality...
June 2018: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/29771483/managing-shoulder-injuries-in-the-emergency-department-fracture-dislocation-and-overuse
#11
Richard Pescatore, Andrew Nyce
The complex structures of the shoulder can be injured by fracture, dislocation, and overuse, and correctly identifying and classifying injury is essential to avoiding pain, disability, and life- and limb-threatening complications. This issue presents a systematic approach to classifying shoulder injuries based on the mechanism of injury and clinical presentation, choosing appropriate imaging, and determining the best strategies for treatment, including reduction, surgical consultation, or outpatient referral...
June 2018: Emergency Medicine Practice
https://www.readbyqxmd.com/read/29771164/retrospective-evaluation-of-clinical-experience-with-intravenous-ascorbic-acid-in-patients-with-cancer
#12
Anthony J Bazzan, George Zabrecky, Nancy Wintering, Andrew B Newberg, Daniel A Monti
BACKGROUND: Intravenous ascorbic acid (IV AA) has been used extensively in cancer patients throughout the United States. Currently, there are limited data on the safety and clinical effects of IV AA. The purpose of this study was to expand the current literature using a retrospective analysis of adverse events and symptomatic changes of IV AA in a large sample of cancer patients. METHODS: We conducted a retrospective chart review of all patients receiving IV AA for cancer at the Thomas Jefferson University Hospital over a 7-year period...
May 1, 2018: Integrative Cancer Therapies
https://www.readbyqxmd.com/read/29769491/management-of-traumatic-unstable-thoracolumbar-spine-conservative-versus-operative-treatment
#13
M M Rahman, N A Islam, M S Islam, M M Rahman, M A Islam, M K Alamgir, M H Sarker
Traumatic thoracolumbar spine injury result in significant instability of the spine and leads to an acute on delayed neurological deficit. Objective of the study is to find a better option in the management of unstable traumatic thoracolumbar spine with incomplete neurological lesion. This was quasi-experimental study. The study was carried out at National Institute of Traumatology & Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh from January 2006 to December 2008. A total number of 40 patients with traumatic thoracolumbar spine injuries with incomplete neurological lesion were selected purposively...
April 2018: Mymensingh Medical Journal: MMJ
https://www.readbyqxmd.com/read/29768401/near-real-time-forecasting-for-cholera-decision-making-in-haiti-after-hurricane-matthew
#14
Damiano Pasetto, Flavio Finger, Anton Camacho, Francesco Grandesso, Sandra Cohuet, Joseph C Lemaitre, Andrew S Azman, Francisco J Luquero, Enrico Bertuzzo, Andrea Rinaldo
Computational models of cholera transmission can provide objective insights into the course of an ongoing epidemic and aid decision making on allocation of health care resources. However, models are typically designed, calibrated and interpreted post-hoc. Here, we report the efforts of a team from academia, field research and humanitarian organizations to model in near real-time the Haitian cholera outbreak after Hurricane Matthew in October 2016, to assess risk and to quantitatively estimate the efficacy of a then ongoing vaccination campaign...
May 16, 2018: PLoS Computational Biology
https://www.readbyqxmd.com/read/29768296/pediatric-diabetic-ketoacidosis-with-hypotensive-shock-and-rash-an-unusual-presentation
#15
Yehonatan Pasternak, Omer Niv, Yehezkel Hezi Waisman
We describe a previously healthy adolescent boy who presented with respiratory distress, hypotensive shock, and a diffuse erythematous rash. The final diagnosis was diabetic ketoacidosis. Caregivers should be alert to this unusual combination of symptoms in the emergency department setting in order to improve the recognition and management of children with new-onset diabetes.
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29768291/quality-of-the-triage-of-children-with-anaphylaxis-at-the-emergency-department
#16
Esozia Arroabarren, Jorge Alvarez-Garcia, Marta Anda, Montserrat de Prada, Maria Carmen Ponce, Miriam Palacios
OBJECTIVE: Early recognition of symptoms is essential in anaphylaxis management. The Canadian Paediatric Emergency Triage and Acuity Scale prioritizes anaphylaxis to level I or II (resuscitation or emergency). We analyzed the accuracy of pediatric anaphylaxis triage. METHODS: This was a retrospective review of the triage charts (adaptation of the Canadian Paediatric Emergency Triage and Acuity Scale) of 137 children attended for anaphylaxis at our pediatric emergency department...
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29766326/the-change-in-management-of-bronchiolitis-in-the-intensive-care-unit-between-2000-and-2015
#17
Minna Mecklin, Paula Heikkilä, Matti Korppi
This case-control study evaluated interventions for bronchiolitis in relation to time in the pediatric intensive care unit (PICU) during a 16-year surveillance period. Together, 105 infants aged < 12 months were treated for bronchiolitis in the PICU, and for them, we selected 210 controls admitted for bronchiolitis closest to cases. We collected data on treatments in the PICU, at the ward and in the emergency department for three periods: years 2000-2005, 2006-2010, and 2011-2015. Median hospital length of stay for PICU patients were 7 days (interquartile range 5-12), 5 days (4-8) and 8 days (4-12...
May 15, 2018: European Journal of Pediatrics
https://www.readbyqxmd.com/read/29765485/spontaneous-hemoperitoneum-resulting-from-segmental-arterial-mediolysis
#18
Emily Olivares, Harlan Vingan, Qiao Zhou
Segmental arterial mediolysis is a rare but potentially life-threatening arteropathy of medium to large arteries that can be managed with endovascular treatment for patients who are hemodynamically unstable. We present a case of segmental arterial mediolysis in a 73-year-old woman who developed spontaneous hemoperitoneum in the emergency department after initially presenting with unrelated upper respiratory complaints. Her initial computed tomography revealed an aneurysm arising off the right hepatic artery...
June 2018: Radiology Case Reports
https://www.readbyqxmd.com/read/29765259/shadowing-emergency-medicine-residents-by-medical-education-specialists-to-provide-feedback-on-non-medical-knowledge-based-acgme-sub-competencies
#19
Anna L Waterbrook, Karen C Spear Ellinwood, T Gail Pritchard, Karen Bertels, Ariel C Johnson, Alice Min, Lisa R Stoneking
Objective: Non-medical knowledge-based sub-competencies (multitasking, professionalism, accountability, patient-centered communication, and team management) are challenging for a supervising emergency medicine (EM) physician to evaluate in real-time on shift while also managing a busy emergency department (ED). This study examines residents' perceptions of having a medical education specialist shadow and evaluate their nonmedical knowledge skills. Methods: Medical education specialists shadowed postgraduate year 1 and postgraduate year 2 EM residents during an ED shift once per academic year...
2018: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/29765242/claims-based-proxies-of-patient-instability-among-commercially-insured-adults-with-schizophrenia
#20
Charles Ruetsch, Hyong Un, Heidi C Waters
Objective: Schizophrenia (Sz) patients are among the highest utilizers of hospital-based services. Prevention of relapse is in part a treatment goal in order to reduce hospital admissions. However, predicting relapse is a challenge, particularly for payers and disease management firms with only access to claims data. Understandably, such organizations have had little success predicting relapse. A tool that allows payers to identify patients at elevated risk of relapse could facilitate targeted interventions prior to relapse and avoid rehospitalization...
2018: ClinicoEconomics and Outcomes Research: CEOR
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