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Emergency Department Management

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https://www.readbyqxmd.com/read/29342449/increased-use-of-adrenaline-in-the-management-of-childhood-anaphylaxis-over-the-last-decade
#1
Kristina Rueter, Brennan Ta, Natasha Bear, Michaela Lucas, Meredith L Borland, Susan L Prescott
BACKGROUND: We recently determined that allergy training programs have improved physician recognition and diagnosis of pediatric anaphylaxis in the last decade. OBJECTIVE: To investigate for changes in management, in particular the appropriate use of adrenaline for the treatment of anaphylaxis in a tertiary pediatric emergency department (PED). METHODS: We conducted a retrospective case note study including children aged 0 to 16 years coded and verified for anaphylaxis comparing cases in years 2003/2004 with 2012...
January 13, 2018: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/29342059/patients-living-alone-can-be-safely-discharged-directly-home-after-total-joint-arthroplasty-a-prospective-cohort-study
#2
Andrew N Fleischman, Matthew S Austin, James J Purtill, Javad Parvizi, William J Hozack
BACKGROUND: Despite the expense and potential hazards of inpatient rehabilitation, there is a prevailing belief that patients living alone cannot be safely discharged directly home after total joint arthroplasty. The purpose of this study was to assess the safety and efficacy of direct home discharge for patients living alone during convalescence after primary total joint arthroplasty. METHODS: We prospectively studied 910 consecutive patients undergoing primary, unilateral total hip arthroplasty or total knee arthroplasty over an 8-month period...
January 17, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29341529/-when-the-ward-overflows%C3%A2-the-impact-of-outlying-beds-on-patient-care
#3
Valérie Mosimann, Olivier Lamy, Julien Castioni
Due to the chronic lack of beds in hospitals, patients are often hospitalized in other departments (outlier patients), with a responsible physician working in another department. This causes increased thromboembolics risks, nosocomial infections, falls and delirium in the elderly, morbidity and mortality. Outlier patients, compared to standard patients, stay longer in the emergency department and their discharge documents are available later. Outlying is used daily in the CHUV hospital and new strategies are elaborated to manage patient flow, especially during the flu epidemic...
January 17, 2018: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29340167/subcutaneous-glucagon-infusion-and-continuous-glucose-monitoring-enable-effective-management-of-hypoglycemia-in-a-patient-with-igf-2-producing-hemangiopericytoma
#4
Eric D Buras, Emily Weatherup, Jennifer Wyckoff
Background: Ectopic insulin-like growth factor (IGF)-2 production is a rare complication of an array of epithelial and mesenchymal tumors, and can clinically manifest as life-threatening hypoglycemia. Case presentation: A 49-year-old woman with 13-year history of metastatic hemangiopericytoma, previously treated with multiple rounds of chemotherapy and palliative radiation, presented to the emergency department after a hypoglycemic seizure. On arrival, glucose was 18 mg/dL (1...
2018: Clinical Diabetes and Endocrinology
https://www.readbyqxmd.com/read/29338852/simulation-based-multidisciplinary-team-training-decreases-time-to-critical-operations-for-trauma-patients
#5
Margaret Murphy, Kate Curtis, Mary K Lam, Cameron S Palmer, Jeremy Hsu, Andrea McCloughen
BACKGROUND: Simulation has been promoted as a platform for training trauma teams. However, it is not clear if this training has an impact on health service delivery and patient outcomes. This study evaluates the association between implementation of a simulation based multidisciplinary trauma team training program at a metropolitan trauma centre and subsequent patient outcomes. METHOD: This was a retrospective review of trauma registry data collected at an 850-bed Level 1 Adult Trauma Centre in Sydney, Australia...
January 8, 2018: Injury
https://www.readbyqxmd.com/read/29337604/the-current-status-of-outcomes-based-contracting-for-manufacturers-and-payers-an-amcp-membership-survey
#6
Amy Duhig, Soumi Saha, Stacie Smith, Stew Kaufman, Janet Hughes
BACKGROUND: As the United States health care system shifts from traditional volume-based payments to value-based payments, outcomes-based contracts (OBCs) are gaining popularity among payers and manufacturers as a mechanism for the shift toward value. Under this model, stakeholders hope to align drug payment and value to real-world performance metrics (e.g., biomarkers and health care resource utilization). OBJECTIVE: To understand the experiences, perceptions, and needs of payers and manufacturers related to OBCs...
December 22, 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29337338/goda-resultat-n%C3%A3-r-akutl%C3%A3-kare-diagnostiserade-djup-ventrombos-dvt-diagnostik-kan-utf%C3%A3-ras-med-ultraljud-p%C3%A3-akuten-enligt-pilotstudie-vid-lasarettet-i-ystad
#7
David Nygren, Caroline Hård Af Segerstad, Catarina Ellehuus Hilmersson, Johan Elf, Ekelund Ulf, Jakob Lundager Forberg
Good outcomes when emergency physicians diagnosed deep vein thrombosis Deep vein thrombosis of the lower limb is best diagnosed with ultrasound. Internationally, several studies have shown promising and often equal results when emergency physicians have been compared with radiologists in diagnosing thrombosis. Our results confirm these findings in a non-academic hospital and for the first time in a Swedish setting. Our findings form the basis for a multi-centre study on new diagnostic routines in patients with suspected proximal deep vein thrombosis in the emergency department, potentially resulting in faster and more resource-effective management...
January 15, 2018: Läkartidningen
https://www.readbyqxmd.com/read/29336754/predictors-and-outcomes-of-nondiagnostic-ultrasound-for-acute-appendicitis-in-children
#8
Richard Sola, Blair A Wormer, William E Anderson, Thomas M Schmelzer, Graham H Cosper
Ultrasound assessments of children with possible acute appendicitis (AA) are often nondiagnostic. We aimed to identify the predictors of nondiagnostic ultrasound and to investigate the outcomes. A retrospective review was conducted on children aged 4 to 17 years evaluated in 2013 for AA with ultrasound at a tertiary hospital pediatric emergency department. Demographics, clinical data, and outcomes were analyzed. Of 528 children, 194 (36.7%) had diagnostic ultrasounds and 334 (63.3%) had nondiagnostic ultrasounds...
December 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/29335822/emergency-department-throughput-an-intervention
#9
Nowreen Haq, Rona Stewart-Corral, Eric Hamrock, Jamie Perin, Waseem Khaliq
Shortening emergency department (ED) boarding time and managing hospital bed capacity by expediting the inpatient discharge process have been challenging for hospitals nationwide. The objective of this study is was to explore the effect of an innovative prospective intervention on hospital workflow, specifically on early inpatient discharges and the ED boarding time. The intervention consisted of a structured nursing "admission discharge transfer" (ADT) protocol receiving new admissions from the ED and helping out floor nursing with early discharges...
January 15, 2018: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29335010/acute-intestinal-obstruction-due-to-extrinsic-compression-by-previa-myoma-and-ectopic-pregnancy-a-case-report
#10
Harissou Adamou, Ibrahim Amadou Magagi, Souleymane Oumarou Garba, Oumarou Habou
BACKGROUND: Acute intestinal obstruction during pregnancy is a rare digestive surgical emergency with significant maternal and fetal mortality. Diagnosis is difficult, often delaying the management. Here, we report an exceptional association of mechanical acute intestinal obstruction due to compression by previa uterine leiomyoma, and a ruptured ectopic pregnancy. CASE PRESENTATION: This is the case report of a 43-year-old primiparous black woman from a rural area, who was admitted to the surgical emergency department for acute intestinal obstruction...
January 16, 2018: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/29334996/italian-guidelines-on-the-assessment-and-management-of-pediatric-head-injury-in-the-emergency-department
#11
REVIEW
Liviana Da Dalt, Niccolo' Parri, Angela Amigoni, Agostino Nocerino, Francesca Selmin, Renzo Manara, Paola Perretta, Maria Paola Vardeu, Silvia Bressan
OBJECTIVE: We aim to formulate evidence-based recommendations to assist physicians decision-making in the assessment and management of children younger than 16 years presenting to the emergency department (ED) following a blunt head trauma with no suspicion of non-accidental injury. METHODS: These guidelines were commissioned by the Italian Society of Pediatric Emergency Medicine and include a systematic review and analysis of the literature published since 2005...
January 15, 2018: Italian Journal of Pediatrics
https://www.readbyqxmd.com/read/29334925/implementing-blended-learning-in-emergency-airway-management-training-a-randomized-controlled-trial
#12
Madeleine Huei Tze Kho, Keng Sheng Chew, Muhaimin Noor Azhar, Mohd Lotfi Hamzah, Kee Man Chuah, Aida Bustam, Hiang Chuan Chan
BACKGROUND: While emergency airway management training is conventionally conducted via face-to-face learning (F2FL) workshops, there are inherent cost, time, place and manpower limitations in running such workshops. Blended learning (BL) refers to the systematic integration of online and face-to-face learning aimed to facilitate complex thinking skills and flexible participation at a reduced financial, time and manpower cost. This study was conducted to evaluate its effectiveness in emergency airway management training...
January 15, 2018: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29334809/accidental-pharmacological-poisonings-in-young-children-population-based-study-in-three-settings
#13
Jane C Bell, Jason P Bentley, Catriona Downie, Rose Cairns, Nicholas A Buckley, Annette Katelaris, Sallie-Anne Pearson, Natasha Nassar
INTRODUCTION: Pharmacological poisonings in young children are avoidable. Previous studies report calls to poisons centres, presentations to emergency departments (ED) or hospital admissions. There are limited data assessing concurrent management of poisonings across all three settings. We aimed to describe accidental pharmacological poisonings in young children across our Poisons Information Centre (PIC), EDs and hospitals. METHODS: A population-based study in New South Wales, Australia, of PIC calls, ED presentations and hospital admissions for accidental pharmacological poisoning in children aged <5 years, 2007-2013...
January 15, 2018: Clinical Toxicology
https://www.readbyqxmd.com/read/29333809/assessment-of-orofacial-pain-management-in-a-pediatric-emergency-department-and-at-home-after-discharge
#14
Yurena Aguilar de la Red, Gema Manrique Martín, Gloria Guerrero López, Concepción González Herrero, Paula López Vázquez, Concepción Míguez Navarro
INTRODUCTION: An inadequate pain management is common in the emergency department. Our objective was to analyze pain management among children with an orofacial infection or trauma in the emergency department and to assess compliance and satisfaction with analgesia prescribed at discharge. POPULATION AND METHODS: Cross-sectional, observational and analytical study in children attending the emergency department for an orofacial infection or trauma over 2 months. Pain management in the emergency department, analgesia prescribed at home and, following a call to parents, treatment provided and its adequacy to control pain were registered...
February 1, 2018: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/29333786/the-added-value-of-the-lateral-chest-radiograph-for-diagnosing-community-acquired-pneumonia-in-the-pediatric-emergency-department
#15
Michalle Soudack, Semion Plotkin, Aviva Ben-Shlush, Lisa Raviv-Zilka, Jeffrey M Jacobson, Michael Benacon, Arie Augarten
BACKGROUND: Opinions differ as to the need of a lateral radiograph for diagnosing community acquired pneumonia in children referred to the emergency department. A lateral radiograph increases the ionizing radiation burden but at the same time may improve specificity and sensitivity in this population. OBJECTIVES: To determine the value of the frontal and lateral chest radiographs compared to frontal view stand-alone images for the management of children with suspected community acquired pneumonia seen in a pediatric emergency department...
January 2018: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/29332187/human-bite-injuries-to-the-head-and-neck-current-trends-and-management-protocols-in-england-and-wales
#16
Glyndwr W Jenkins, Robert Isaac, Shakir Mustafa
INTRODUCTION: Human bite injuries can be challenging in their presentation to the examining physician. In a study by Merchant et al., 18% of patients presenting with a human bite injury had suffered wounds to the head and neck region. Current trends in their initial management at presentation to emergency departments throughout England and Wales will be discussed in this paper. MATERIALS AND METHOD: A postal survey was sent out to 100 A&E lead clinicians. This was followed up by telephone enquiries to improve the response rate...
January 14, 2018: Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29331328/pilot-clinical-trial-of-high-flow-oxygen-therapy-in-children-with-asthma-in-the-emergency-service
#17
Yolanda Ballestero, Jimena De Pedro, Nancy Portillo, Otilia Martinez-Mugica, Eunate Arana-Arri, Javier Benito
OBJECTIVES: To assess the efficacy of high-flow nasal cannula (HFNC) oxygen therapy and safety in children with asthma and moderate respiratory failure in the emergency department (ED). STUDY DESIGN: This was a prospective randomized pilot trial of children (aged 1-14 years) presenting to a tertiary academic pediatric ED with moderate-to-severe asthma exacerbations between September 2012 and December 2015. Patients with a pulmonary score (PS) ≥6 or oxygen saturation <94% with a face mask despite initial treatment (salbutamol/ipratropium bromide and corticosteroids) were randomized to HFNC or to conventional oxygen therapy...
January 11, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29331005/pregnant-lady-with-undiagnosed-hodgkin-s-disease-presenting-as-secondary-sclerosing-cholangitis
#18
Taif Khattak, Syed Hashim Ali Shah, Waqas Khan, Syed Shahmeer Raza, Uzair Ahmad, Farhan Ullah
Hodgkin's lymphoma. A 25 years old lady, 34 weeks primigravida was referred from the Emergency Department to the Medical Unit Khyber Teaching Hospital-MTI, Peshawar with four weeks of fever, progressive jaundice, pruritus, night sweats and weight loss. LFTs showed cholestatic picture, ERCP showed scanty intrahepatic giving beading and autumn tree appearance typical of sclerosing cholangitis. CBD was normal. Doppler U/S of hepatic and portal vein reported normal. She was started on steroids, ursodeoxycholic acid and antibiotics 3rd generation cephalosporins to which she did not respond well...
October 2017: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/29328897/high-users-of-healthcare-strategies-to-improve-care-reduce-costs
#19
REVIEW
Neil Siekman, Rick Hilger
A minority of patients consume a disproportionate amount of healthcare, especially in the emergency department. These "high users" are a small but complex group whose expenses are driven largely by low socioeconomic status, mental illness, and drug abuse; lack of social services also contributes. Several promising efforts aimed at improving quality and reducing healthcare costs for high users include care management organizations, patient care plans, and better discharge summaries.
January 2018: Cleveland Clinic Journal of Medicine
https://www.readbyqxmd.com/read/29328792/identification-and-management-of-nontraumatic-splenic-rupture
#20
Samanthi De Silva
A 43-year old previously fit and well gentleman presented to the emergency department (ED) with a two day history of worsening epigastric pain. He had had coryzal symptoms the preceding week but had no other past medical history. He was haemodynamically stable at presentation and an ultrasound scan (US) performed in the ED could not definitively rule out intra-abdominal fluid. In view of his tender abdomen on examination and a haemoglobin level of 9.2g/dL, a computerised tomography (CT) scan was performed and revealed extensive high-density fluid within the peritoneal cavity, raising the possibility of a concealed bleed but no obvious source was identified by the scan...
December 2017: Journal of Perioperative Practice
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