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https://www.readbyqxmd.com/read/29149776/effect-of-nebulized-3-hypertonic-saline-with-salbutamol-on-management-of-acute-asthma-in-outpatient-adults-a-double-blind-randomized-clinical-trial-in-emergency-department
#1
Arash Forouzan, Kambiz Masoumi, Ali Delirrooyfard, Ali Asgari Darian, Laaya Mokhtar Gandomani
Asthma is one of the most common disorders of respiratory tract, management of which still remains as a serious health problem. This study aimed to compare the efficacy of 3% hypertonic saline (HS) plus salbutamol with solely salbutamol on management of acute adults' asthma based on peak flow meter findings. In this double-blind randomized clinical trial, 340 adult patients with acute asthma attacks admitted to emergency department of Ahvaz Golestan and Emam hospitals were enrolled during 2014-2015. The patients were allocated randomly to intervention group (nebulized 2...
October 2017: Iranian Journal of Allergy, Asthma, and Immunology
https://www.readbyqxmd.com/read/29149393/challenges-in-minor-tbi-and-indications-for-head-ct-in-pediatric-tbi-an-update
#2
Navneet Singh, Ash Singhal
INTRODUCTION: Pediatric head trauma is one of the commonest presentations to emergency departments. Over 90% of such head injuries are considered mild, but still present risk acute clinical deterioration and longer term morbidity. Identifying which children are at risk of clinically important brain injuries remains challenging and much of the data on minor head injuries is based on the adult population. CHALLENGES IN PEDIATRICS: Children, however, are different, both anatomically and in terms of mechanism of injury, to adults and, even within the pediatric group, there are differences with age and stage of development...
October 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/29137906/can-different-physicians-providing-urgent-and-non-urgent-treatment-improve-patient-flow-in-emergency-department
#3
Flora Fei-Fei Yau, Tsung-Cheng Tsai, Yan-Ren Lin, Kuan-Han Wu, Yuan-Jhen Syue, Chao-Jui Li
BACKGROUND: Emergency Department (ED) overcrowding is a worldwide problem, and it might be caused by prolonged patient stay in the ED. This study tried to analyze if different practice models influence patient flow in the ED. MATERIALS AND METHODS: A retrospective, 1-year cohort study was conducted across two EDs in the largest healthcare system in Taiwan. A total of 37,580 adult non-trauma patients were involved in the study. The clinical practice between two ED practice models was compared...
November 6, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29133324/effects-of-falls-prevention-interventions-on-falls-outcomes-for-hospitalised-adults-protocol-for-a-systematic-review-with-meta-analysis
#4
Susan C Slade, David L Carey, Anne-Marie Hill, Meg E Morris
INTRODUCTION: Falls are a major global public health problem and leading cause of accidental or unintentional injury and hospitalisation. Falls in hospital are associated with longer length of stay, readmissions and poor outcomes. Falls prevention is informed by knowledge of reversible falls risk factors and accurate risk identification. The extent to which hospital falls are prevented by evidence-based practice, patient self-management initiatives, environmental modifications and optimisation of falls prevention systems awaits confirmation...
November 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/29132572/secondary-gains-advances-in-neurotrauma-management
#5
REVIEW
Brit Long, Alex Koyfman
Neurotrauma is a leading cause of death and is associated with many secondary injuries. A balance of mean arterial pressure (MAP) and intracranial pressure (ICP) is required to ensure adequate cerebral blood flow and cerebral perfusion pressure. Evaluation and management in the emergency department entails initial stabilization and resuscitation while assessing neurologic status. ICP management follows a tiered approach. Intubation requires consideration of preoxygenation, head of bed elevation, first pass success, and adequate analgesia and sedation...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29121883/the-association-of-duration-of-boarding-in-the-emergency-room-and-the-outcome-of-patients-admitted-to-the-intensive-care-unit
#6
Saad Al-Qahtani, Abdullah Alsultan, Samir Haddad, Abdulmohsen Alsaawi, Moeed Alshehri, Sami Alsolamy, Afef Felebaman, Hani M Tamim, Nawfal Aljerian, Abdulaziz Al-Dawood, Yaseen Arabi
BACKGROUND: The demand for critical care beds is increasing out of proportion to bed availability. As a result, some critically ill patients are kept in the Emergency Department (ED boarding) awaiting bed availability. The aim of our study is to examine the impact of boarding in the ED on the outcome of patients admitted to the Intensive Care Unit(ICU). METHODS: This was a retrospective analysis of ICU data collected prospectively at King Abdulaziz Medical City, Riyadh from ED between January 2010 and December 2012 and all patients admitted during this time were evaluated for their duration of boarding...
November 9, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29119470/failure-to-flow-an-exploration-of-learning-and-teaching-in-busy-multi-patient-environments-using-an-interpretive-description-method
#7
Teresa M Chan, Kenneth Van Dewark, Jonathan Sherbino, Alan Schwartz, Geoff Norman, Matthew Lineberry
INTRODUCTION: As patient volumes continue to increase, more attention must be paid to skills that foster efficiency without sacrificing patient safety. The emergency department is a fertile ground for examining leadership and management skills, especially those that concern prioritization in multi-patient environments. We sought to understand the needs of emergency physicians (EPs) and emergency medicine junior trainees with regards to teaching and learning about how best to handle busy, multi-patient environments...
November 8, 2017: Perspectives on Medical Education
https://www.readbyqxmd.com/read/29117454/factors-affecting-quality-of-nurse-shift-handover-in-the-emergency-department
#8
Heather Thomson, Ann Tourangeau, Lianne Jeffs, Martine Puts
AIM: The aim of this study was to explore and test factors hypothesized to influence quality of Emergency Department nurse-to-nurse shift handover communication. BACKGROUND: Nurse-to-nurse shift handover communication includes the transfer of information and responsibility for patients at shift change. The unique environment of the Emergency Department, where there is a high degree of patient unpredictability, increased patient volumes and rapid patient turnover, can create challenges for high quality handover communication...
November 8, 2017: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/29096344/endovascular-treatment-of-ruptured-pancreaticoduodenal-artery-aneurysm-the-importance-of-collateral-vessels-a-case-report
#9
Gabriele Ricci, Pascale Riu, Grazia Maria Attinà, Silvia Trombetta, Pasquale Ialongo, Carla Di Cosimo, Rosaria Mancuso, Pierluigi Marini
INTRODUCTION: True pancreaticoduodenal artery aneurysm occurrence is infrequent, but it is a fatal disease and accounts for accounts for <2% of all visceral aneurysms. PRESENTATION OF CASE: A 62-year-old man with a two-day history of epigastric pain was admitted at emergency department. CT showed a retroperitoneal haematoma due to a 1.5cm posterior inferior PDA ruptured aneurysm. Angiography had been conducted immediately: both inflow and outflow of the aneurysm were embolized...
October 26, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29069141/intra-arterial-fibrinolysis-for-the-management-of-acute-ischemia-on-a-below-knee-amputation-stump-case-report
#10
Breno Boueri Affonso, Joaquim Maurício da Motta Leal, Rafael Noronha Cavalcante, Priscila Mina Falsarella, Francisco Leonardo Galastri, Rodolfo Souza Cardoso, Felipe Nasser
Preservation of the knee joint has enormous advantages in terms of mobility and rehabilitation of an amputee. Any cause of breakdown requiring revision to an above-knee amputation is a major setback because it reduces the patient's rehabilitative potential. We report a case of intra-arterial thrombolysis use to save a below-knee amputation stump with acute ischemia. A 56-year-old man who sought the emergency department with 1-day history of acute pain on his right below-knee stump. The angiography confirmed popliteal artery occlusion...
October 23, 2017: Einstein
https://www.readbyqxmd.com/read/29062385/central-nervous-system-and-limb-embolism-concurrence-due-to-atrial-myxoma-a-case-report%C3%A2
#11
Javad Salimi, Khosro Najari, Pezhman Farshidmehr, Roja Toosi, Batool Naghavi, Tayeb Ramim
Cardiac myxomas are the most common cardiac tumors with diverse nonspecific clinical manifestations. A 78-year-old man presented to the emergency department with complaints of pain and coldness of the left lower extremity. The left femoral artery pulse was detected, while the pulses of the left popliteal, dorsalis pedis, and posterior tibialis arteries were absent. No blood inflow was detected in the superficial and deep femoral, popliteal, and anterior and posterior tibialis arteries. Thrombectomy was performed, and a fatty-like mass from the bifurcation of the common femoral artery and a thrombotic mass from the proximal portion of the superficial and deep femoral arteries were removed...
July 2017: Journal of Tehran Heart Center
https://www.readbyqxmd.com/read/29045097/management-of-airway-obstruction-and-stridor-in-pediatric-patients
#12
Ashley Marchese, Melissa L. Langhan
Stridor is a result of turbulent air-flow through the trachea from upper airway obstruction, and although in children it is often due to croup, it can also be caused by noninfectious and/or congenital conditions as well as life-threatening etiologies. The history and physical examination guide initial management, which includes reduction of airway inflammation, treatment of bacterial infection, and, less often, imaging, emergent airway stabilization, or surgical management. This issue discusses the most common as well as the life-threatening etiologies of acute and chronic stridor and its management in the emergency department...
November 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/29042484/accuracy-of-oxygen-flow-delivered-by-compressed-gas-cylinders-in-hospital-and-prehospital-emergency-care
#13
Frédéric Duprez, Jean Bernard Michotte, Gregory Cuvelier, Alexandre Legrand, Sharam Mashayekhi, Gregory Reychler
BACKGROUND: Oxygen cylinders are widely used both in hospital and prehospital care. Excessive or inappropriate FIO2 may be critical for patients with hypercapnia or hypoxia. Moreover, over-oxygenation could be deleterious in ischemic disorders. Supplemental oxygen from oxygen cylinder should therefore be delivered accurately. The aim of this study was to assess the accuracy of oxygen flows for oxygen cylinder in hospital and prehospital care. METHODS: A prospective trial was conducted to evaluate accuracy of delivered oxygen flows (2, 4, 6, 9 and 12 L/min) for different oxygen cylinder ready for use in different hospital departments...
October 17, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29024416/review-article-a-systematic-review-of-emergency-department-incident-classification-frameworks
#14
REVIEW
Matthew Murray, Sally McCarthy
As in any part of the hospital system, safety incidents can occur in the ED. These incidents arguably have a distinct character, as the ED involves unscheduled flows of urgent patients who require disparate services. To aid understanding of safety issues and support risk management of the ED, a comparison of published ED specific incident classification frameworks was performed. A review of emergency medicine, health management and general medical publications, using Ovid SP to interrogate Medline (1976-2016) was undertaken to identify any type of taxonomy or classification-like framework for ED related incidents...
October 11, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28971638/computed-tomography-perfusion-maps-reveal-blood-flow-dynamics-in-postictal-patients-a-novel-diagnostic-tool
#15
Shahar Shelly, Nicola Maggio, Marina Boxer, Ilan Blatt, David Tanne, David Orion
BACKGROUND: Computed tomography (CT) brain perfusion is a relatively new imaging method that can be used to differentiate patients following epileptic seizures in the setting of acute neurological deficits (e.g., hemiparesis, hemiplegia, hemianopsia, aphasia) who arrive at the emergency room with a suspected stroke. OBJECTIVES: To evaluate brain perfusion changes in patients who had an epileptic seizure. METHODS: We retrospectively identified 721 patients who presented at our stroke center between 2012 and 2015 with a suspected acute stroke and underwent examination thorough a stroke protocol, including cerebral CT perfusion (CTP) and CT angiography (CTA) within 8 hours from the onset of symptoms...
September 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28970026/the-impact-of-the-improvement-in-internal-medicine-consultation-process-on-emergency-department-length-of-stay
#16
Sangheon Shin, Soo Hoon Lee, Dong Hoon Kim, Seong Chun Kim, Tae Yun Kim, Changwoo Kang, Jin Hee Jeong, Daesung Lim, Yong Joo Park, Sang Bong Lee
INTRODUCTION: Although consultations are essential for delivering safe, high-quality care to patients in emergency departments, they contribute to emergency department patient flow problems and overcrowding which is associated with several adverse outcomes, such as increases in patient mortality and poor quality care. This study aimed to investigate how time flow metrics including emergency department length of stay is influenced by changes to the internal medicine consultation policy...
September 28, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28953294/job-satisfaction-among-academic-family-physicians
#17
Denny Fe Agana, Maribeth Porter, Robert Hatch, Daniel Rubin, Peter Carek
BACKGROUND AND OBJECTIVES: Family physicians report some of the highest rates of burnout among their physician peers. Over the past few years, this rate has increased and work-life balance has decreased. In academic medicine, many report lack of career satisfaction and have considered leaving academia. Our aim was to explore the factors that contribute to job satisfaction and burnout in faculty members in a family medicine department. METHODS: Six academic family medicine clinics were invited to participate in this qualitative study...
September 2017: Family Medicine
https://www.readbyqxmd.com/read/28950856/new-zealand-s-emergency-department-target-did-it-reduce-ed-length-of-stay-and-if-so-how-and-when
#18
Tim Tenbensel, Linda Chalmers, Peter Jones, Sarah Appleton-Dyer, Lisa Walton, Shanthi Ameratunga
BACKGROUND: In 2009, the New Zealand government introduced a hospital emergency department (ED) target - 95% of patients seen, treated or discharged within 6 h - in order to alleviate crowding in public hospital EDs. While these targets were largely met by 2012, research suggests that such targets can be met without corresponding overall reductions in ED length-of-stay (LOS). Our research explores whether the NZ ED time target actually reduced ED LOS, and if so, how and when. METHODS: We adopted a mixed-methods approach with integration of data sources...
September 26, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28947391/could-post-mortem-computed-tomography-angiography-inform-cardiopulmonary-resuscitation-research
#19
Guy N Rutty, Claire Robinson, Jasmin Amoroso, Tim Coats, Bruno Morgan
AIM: Firstly, to develop an optimised chest compression post mortem computed tomography angiography protocol in the adult human during closed chest compression to investigate cardiopulmonary resuscitation blood flow, and secondly to provide preliminary observations of post-mortem anatomical cardiac chamber movement using a novel radiolucent static chest compression device. METHODS: Variable volumes of radiological contrast agent were injected intravenously into a series of consented human cadavers...
September 23, 2017: Resuscitation
https://www.readbyqxmd.com/read/28941792/multidisciplinary-evaluation-of-an-emergency-department-nurse-navigator-role-a-mixed-methods-study
#20
Melanie Jessup, Paul Fulbrook, Frances B Kinnear
AIM: To utilise multidisciplinary staff feedback to assess their perceptions of a novel emergency department nurse navigator role and to understand the impact of the role on the department. BACKGROUND: Prolonged emergency department stays impact patients, staff and quality of care, and are linked to increased morbidity and mortality. One innovative strategy to facilitate patient flow is the navigator: a nurse supporting staff in care delivery to enhance efficient, timely movement of patients through the department...
September 20, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
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