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Emergency department observation unit

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https://www.readbyqxmd.com/read/29153907/-violent-outburst-from-teenagers-in-the-pediatric-emergency-room-complex-cases
#1
L Cohen, C Gras-Le Guenb, J Fleury, E Caldagues, L Dreno, G Picherot, N Vabres
INTRODUCTION: Teenagers admitted to the emergency room for a violent attacks episode are increasingly numerous. The source of agitation is multifactorial for these teenagers, often with a complex course. They jeopardize hospital wards, which are often ill-suited for and overwhelmed during these outbursts. This study aims to identify and describe all the teenagers admitted to the hospital over 1 year for a violent outburst and discuss their management. METHODS AND EQUIPMENT: Retrospective and descriptive study of teenagers admitted to the pediatric emergency department of the Nantes University Hospital for a violent outburst in 2015...
November 16, 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/29151053/protocol-of-the-sepsivit-study-a-prospective-observational-study-to-determine-whether-continuous-heart-rate-variability-measurement-during-the-first-48-hours-of-hospitalisation-provides-an-early-warning-for-deterioration-in-patients-presenting-with-infection
#2
Vincent M Quinten, Matijs van Meurs, Maurits H Renes, Jack J M Ligtenberg, Jan C Ter Maaten
INTRODUCTION: One in five patients with sepsis deteriorates within 48 hours after hospital admission. Regrettably, a clear tool for the early detection of deterioration is still lacking. The SepsiVit study aims to determine whether continuous heart rate variability (HRV) measurement can provide an early warning for deterioration in patients presenting with suspected infection or sepsis to the emergency department (ED). METHODS AND ANALYSIS: The protocol of a prospective observational study in the ED...
November 17, 2017: BMJ Open
https://www.readbyqxmd.com/read/29141664/prevalence-and-prognosis-of-acutely-ill-patients-with-organ-failure-at-arrival-to-hospital-protocol-for-a-systematic-review
#3
Peter Bank Pedersen, Asbjorn Hrobjartsson, Daniel Lykke Nielsen, Daniel Pilsgaard Henriksen, Mikkel Brabrand, Annmarie Touborg Lassen
BACKGROUND: Acutely ill patients are a heterogeneous group, and some of these suffer from organ failure. As the prognosis of organ failure improves with early treatment, it is important to identify these patients as early as possible. Most studies on organ failure have been performed in intensive care settings, or on selected groups of patients, where a high prevalence and mortality have been reported. Before patients arrive to the intensive care unit, or the general ward, most of them have passed through the emergency department (ED), where diagnosis and treatment has been initiated...
November 15, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/29135621/efficacy-of-implementation-of-a-chest-pain-center-at-a-community-hospital
#4
Alexandra Davis, Jason Chiu, Stanley K Lau, Yih Jen Kok, Jonathan Y H Wu
INTRODUCTION: Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, <20% of the patients have acute coronary syndrome that require immediate attention. The HEART score is designed for rapid risk stratification of ED chest pain patients using the following criteria: history, electrocardiogram, age, risk factors, and troponin. It has been shown to be superior in identifying patients with low (HEART score 0-3) and high (7-10) risk of major adverse cardiac events, who can then be rapidly discharged or admitted for intervention...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29129552/clinical-characteristics-of-suicidal-behavior-in-an-intensive-care-unit-at-a-university-hospital-in-japan-a-7-year-observational-study
#5
Takashi Takeuchi, Yasuyuki Okumura, Akihito Uezato, Toru Nishikawa
BACKGROUND: Suicidal behavior accounts for at least 40,000 admissions per year to emergency departments in Japan; however, little is known about emergency admissions owing to suicidal behavior in metropolitan areas. Therefore, we examined the clinical characteristics of suicidal behavior using psychosocial assessments performed by experienced psychiatrists in an intensive care unit. METHODS: Participants were 971 patients admitted to a university hospital's intensive care unit for suicidal behavior between July 2006 and June 2013...
November 7, 2017: Asian Journal of Psychiatry
https://www.readbyqxmd.com/read/29125229/observational-review-of-paediatric-intraosseous-needle-placement-in-the-paediatric-emergency-department
#6
Elysha L Pifko, Amanda Price, Carrie Busch, Curren Smith, Yunyun Jiang, Joseph Dobson, Rachel Tuuri
AIM: Intraosseous (IO) access is a life-saving option during resuscitations in the paediatric emergency department (PED). This study aimed to compare success rates and time to placement for Manual IO versus EZ-IO needles in PED patients ≤8 and >8 kg. METHODS: This was a retrospective cross-sectional descriptive study of IO use in a single-centre tertiary PED from 2006 to 2014. Cases were identified through diagnosis codes for IO infusion, cardiopulmonary resuscitation and cardiac arrest and admissions to the intensive care unit...
November 10, 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/29121105/economic-evaluation-of-the-one-hour-rule-out-and-rule-in-algorithm-for-acute-myocardial-infarction-using-the-high-sensitivity-cardiac-troponin-t-assay-in-the-emergency-department
#7
Apoorva Ambavane, Bertil Lindahl, Evangelos Giannitis, Julie Roiz, Joan Mendivil, Lutz Frankenstein, Richard Body, Michael Christ, Roland Bingisser, Aitor Alquezar, Christian Mueller
BACKGROUND: The 1-hour (h) algorithm triages patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED) towards "rule-out," "rule-in," or "observation," depending on baseline and 1-h levels of high-sensitivity cardiac troponin (hs-cTn). The economic consequences of applying the accelerated 1-h algorithm are unknown. METHODS AND FINDINGS: We performed a post-hoc economic analysis in a large, diagnostic, multicenter study of hs-cTnT using central adjudication of the final diagnosis by two independent cardiologists...
2017: PloS One
https://www.readbyqxmd.com/read/29117900/gestalt-for-shock-and-mortality-in-the-emergency-department-a-prospective-study
#8
Yan-Ling Li, Jun-Rong Mo, Nga-Man Cheng, Stewart S W Chan, Pei-Yi Lin, Xiao-Hui Chen, Colin A Graham, Timothy H Rainer
OBJECTIVE: The diagnosis of shock in patients presenting to the emergency department (ED) is often challenging. We aimed to compare the accuracy of experienced emergency physician gestalt against Li's pragmatic shock (LiPS) tool for predicting the likelihood of shock in the emergency department, using 30-day mortality as an objective standard. METHOD: In a prospective observational study conducted in an urban, academic ED in Hong Kong, adult patients aged 18years or older admitted to the resuscitation room or high dependency unit were recruited...
November 3, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29116997/hospital-differences-drive-antibiotic-delays-for-black-patients-compared-with-white-patients-with-suspected-septic-shock
#9
Stephanie Parks Taylor, Colleen H Karvetski, Megan A Templin, Brice T Taylor
OBJECTIVE: Evaluate racial disparities in sepsis processes of care. DESIGN: Observational cohort study. SETTING: Nine hospitals in the Southeastern United States between 2014 and 2016. PATIENTS: Two thousand two hundred twenty-one white and 707 black patients treated in the emergency department through "code sepsis" pathway for suspected septic shock. MEASUREMENTS AND MAIN RESULTS: Black patients were less likely to receive timely antibiotics than were white patients using multiple definitions (1 hr from code sepsis activation [odds ratio, 0...
November 7, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29116359/use-of-automated-external-defibrillators-for-in-hospital-cardiac-arrest-any-time-any-place
#10
A Wutzler, C Kloppe, A K Bilgard, A Mügge, C Hanefeld
BACKGROUND: Acute treatment of in-hospital cardiac arrest (IHCA) is challenging and overall survival rates are low. However, data on the use of public-access automated external defibrillators (AEDs) for IHCA remain controversial. The aim of our study was to evaluate characteristics of patients experiencing IHCA and feasibility of public-access AED use for resuscitation in a university hospital. METHODS: IHCA events outside the intensive care unit were analysed over a period of 21 months...
November 7, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29115370/-febrile-syndromes-in-the-traveler-returning-from-tropical-regions-admitted-in-a-monographic-unit
#11
N Moya Notario, M Hernández-Cabrera, C Carranza-Rodríguez, E Pisos-Álamo, N Jaén-Sánchez, J L Pérez-Arellano
OBJECTIVE: The aim was to analyse those syndromes with fever in travellers who return from tropical regions evaluated at our Department of Infectology and Tropical Medicine. Clarifying these conditions intends to reach earlier diagnoses and, perhaps, to avoid the emergence and spread of imported diseases, as well as to establish appropriate preventive measures. METHODS: An observational descriptive transversal study was performed, selecting those patients who returned from tropical regions with fever, amongst all travellers evaluated in our department between 1998 and 2013...
November 8, 2017: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
https://www.readbyqxmd.com/read/29114078/patient-selection-for-high-sensitivity-cardiac-troponin-testing-and-diagnosis-of-myocardial-infarction-prospective-cohort-study
#12
MULTICENTER STUDY
Anoop S V Shah, Yader Sandoval, Ala Noaman, Anne Sexter, Amar Vaswani, Stephen W Smith, Mathew Gibbins, Megan Griffiths, Andrew R Chapman, Fiona E Strachan, Atul Anand, Martin A Denvir, Philip D Adamson, Michelle S D'Souza, Alasdair J Gray, David A McAllister, David E Newby, Fred S Apple, Nicholas L Mills
Objective To evaluate how selection of patients for high sensitivity cardiac troponin testing affects the diagnosis of myocardial infarction across different healthcare settings.Design Prospective study of three independent consecutive patient populations presenting to emergency departments.Setting Secondary and tertiary care hospitals in the United Kingdom and United States.Participants High sensitivity cardiac troponin I concentrations were measured in 8500 consecutive patients presenting to emergency departments: unselected patients in the UK (n=1054) and two selected populations of patients in whom troponin testing was requested by the attending clinician in the UK (n=5815) and the US (n=1631)...
November 7, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/29105063/distinguishing-characteristics-of-headache-in-nontraumatic-subarachnoid-hemorrhage
#13
Brian Mac Grory, Linh Vu, Shawna Cutting, Evadne Marcolini, Christopher Gottschalk, David Greer
INTRODUCTION: Subarachnoid hemorrhage (SAH) is a life-threatening emergency that is frequently missed due to its varied and often subtle presentation. The most common presentation of SAH is with a severe headache. The classical adjective used in SAH is "thunderclap"; however, this has not been well defined in the literature, rendering it a challenge to triage patients in clinical practice presenting with severe headache. METHODS: We undertook a prospective, observational study at a tertiary academic medical center examining the clinical characteristics of the presenting headache in SAH...
November 4, 2017: Headache
https://www.readbyqxmd.com/read/29102746/associations-of-herbs-and-nonvitamin-dietary-supplements-use-with-clinical-outcomes-among-adult-and-pediatric-patients-with-asthma-in-the-united-states
#14
Nan Huo, Jingjing Qian
BACKGROUND: Herbs and nonvitamin dietary supplements (NVDS) have been commonly used among patients with asthma, yet evidence of their impact on patients' clinical outcomes is limited. OBJECTIVE: This study examined the associations of herbs and NVDS use with asthma episodes and asthma-related emergency department (ED) visits among US adults and pediatric patients with asthma. METHODS: A cross-sectional analysis of the 2012 National Health Interview Survey data included 2,930 US adults and 1923 children with self-reported asthma...
November 1, 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/29095899/a-systematic-review-of-emergency-department-based-hiv-testing-and-linkage-to-care-initiatives-in-low-resource-settings
#15
Bhakti Hansoti, Gabor D Kelen, Thomas C Quinn, Madeleine M Whalen, Taylor T DesRosiers, Steven J Reynolds, Andrew Redd, Richard E Rothman
INTRODUCTION: Only 45% of people currently living with HIV infection in sub-Saharan Africa are aware of their HIV status. Unmet testing needs may be addressed by utilizing the Emergency Department (ED) as an innovative testing venue in low and middle-income countries (LMICs). The purpose of this review is to examine the burden of HIV infection described in EDs in LMICs, with a focus on summarizing the implementation of various ED-based HIV testing strategies. METHODOLOGY AND RESULTS: We performed a systematic review of Pubmed, Embase, Scopus, Web of Science and the Cochrane Library on June 12, 2016...
2017: PloS One
https://www.readbyqxmd.com/read/29089817/rainfall-associated-bronchospasm-epidemics-the-epidemiological-effects-of-air-pollutants-and-weather-variables
#16
Kambiz Masoumi, Maryam Haddadzadeh Shoushtari, Arash Forouzan, Ali Asgari Darian, Maryam Dastoorpoor, Pegah Ebrahimzadeh, Hamidreza Aghababaeian
BACKGROUND: This study compares different risk factors in patients visiting a hospital during five rainfall-associated bronchospasm epidemics in Ahvaz and those visiting on other occasions. METHODS: This case-control study was conducted on 5307 patients with bronchospasm admitted to the Emergency Department of Imam Khomeini Hospital in Ahvaz (Iran) from late October to December (as the epidemic) and 916 patients admitted from late January to March (as the nonepidemic) in 2011 to 2015...
2017: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
https://www.readbyqxmd.com/read/29084129/analysis-of-incidents-of-violence-in-a-large-italian-hospital
#17
Dimitri Sossai, Francesco Stefano Molina, Mario Amore, Giovanna Ferrandes, Elena Sarcletti, Gabriella Biffa, Simone Accorsi, Martino Belvederi Murri, Marzia Jole Tomellini, Francesco Copello
INTRODUCTION: An increase in the rate of non-fatal violence events, from 20.65/10,000 in 2012 to 22.81/10,000 in 2014, was observed at the IRCCS Ospedale Policlinico San Martino in Genoa. OBJECTIVES: To analyze the incidence and outcome of the phenomenon of violence, by identifying the type of aggressive event and the ward in which it occurred, assuming that the occurrence is evenly distributed and not only limited to the psychiatric or to the emergency department...
October 27, 2017: La Medicina del Lavoro
https://www.readbyqxmd.com/read/29079375/allergic-like-contrast-reactions-in-the-ed-incidence-management-and-impact-on-patient-disposition
#18
Ravi V Gottumukkala, McKinley Glover, Brian J Yun, Jonathan D Sonis, Mannudeep K Kalra, Alexi Otrakji, Ali S Raja, Anand M Prabhakar
PURPOSE: Determine the incidence, management, and impact on patient disposition of allergic-like contrast reactions (ALCR) to intravenous iodinated contrast in the emergency department (ED). METHODS: All ED patients who developed an ALCR following contrast-enhanced CT (CECT) from June 2011-December 2016 were retrospectively identified. Medical records were reviewed and reaction severity, management, and disposition were quantified using descriptive statistics. The total number of consecutive CECTs performed in the ED were available from June 2011-March 2016 and were used to derive ALCR incidence over that time period...
October 12, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29068438/clinical-decision-making-observing-the-smartphone-user-an-observational-study-in-predicting-acute-surgical-patients-suitability-for-discharge
#19
Richard Hoffman, Simon Harley, Samuel Ellison, Peter G Devitt
INTRODUCTION: An accurate and rapid assessment of an acutely unwell patient's clinical status is paramount for the physician. There is an increasing trend to rely on investigations and results to inform a clinician of a patient's clinical status, with the subtleties of clinical observation often ignored. The aim of this study was to determine if a patient's use of a smartphone during the initial clinical assessment by a surgical consultant could be used as a surrogate marker for patient well-being, represented as their suitability for sameday discharge...
August 23, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29061499/reducing-inappropriate-testing-for-the-evaluation-of-diarrhea-among-hospitalized-patients
#20
Chad E Tewell, Thomas R Talbot, George E Nelson, Bryan D Harris, Whitney A Jones, Narinder Midha, David P Mulherin, Eric B Stephens, Anuj Thirwani, Patty W Wright
BACKGROUND: Diarrhea is one of the most common illnesses in the United States. Evaluation frequently does not follow established guidelines. To evaluate the effectiveness of a computerized physician order entry based test guidance algorithm with regards to the clinical, financial, and operational impacts. METHODS: Our population was patients with diarrheal illness at a tertiary academic medical center. The intervention was a computerized physician order entry (CPOE) based test guidance algorithm that restricted the use of stool cultures and ova and parasites testing of diarrhea in the adult inpatient location versus non-intervention sites which were the emergency department, pediatric inpatient, and outpatient locations...
October 20, 2017: American Journal of Medicine
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