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Acute Triage

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https://www.readbyqxmd.com/read/28211119/cross-sectional-study-of-emergency-department-presentation-triage-categories-at-goondiwindi-hospital-and-their-effect-on-the-treatment-of-acute-emergencies
#1
Ashraf Saleh
OBJECTIVE: The objective of this study was to investigate the number and proportion of non-acute presentations to a district hospital emergency department in Goondiwindi, a rural Queensland town, both in the treatment of emergency cases and potential barriers patients have in seeing a medical practitioner in the general practice setting. DESIGN: Occasions of service to Goondiwindi Hospital were collated from administrative records according to Australasian Triage Scale categories and analysed by Student's t-test for monthly variations in triage category presentations...
February 17, 2017: Australian Journal of Rural Health
https://www.readbyqxmd.com/read/28207167/bisap-ranson-lactate-and-others-biomarkers-in-prediction-of-severe-acute-pancreatitis-in-a-european-cohort
#2
Francisco Valverde-López, Ana M Matas-Cobos, Carlos Alegría-Motte, Rita Jiménez-Rosales, Margarita Úbeda-Muñoz, Eduardo Redondo-Cerezo
BACKGROUND AND AIM: Assessing and comparing the predicting ability of some scores and biomarkers in Acute Pancreatitis (AP). METHODS: We prospectively collected data from 269 patients diagnosed of AP, admitted to Virgen de las Nieves University Hospital between June 2010 and June 2012. Blood urea nitrogen (BUN), C-reactive protein (CRP) and creatinine (Cr) were measured on admission and after 48 hours, lactate and BISAP only on admission and RANSON within the first 48 hours...
February 16, 2017: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28187803/management-of-acute-traumatic-spinal-cord-injuries
#3
C D Shank, B C Walters, M N Hadley
Acute traumatic spinal cord injury (SCI) is a devastating disease process affecting tens of thousands of people across the USA each year. Despite the increase in primary prevention measures, such as educational programs, motor vehicle speed limits, automobile running lights, and safety technology that includes automobile passive restraint systems and airbags, SCIs continue to carry substantial permanent morbidity and mortality. Medical measures implemented following the initial injury are designed to limit secondary insult to the spinal cord and to stabilize the spinal column in an attempt to decrease devastating sequelae...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28181127/role-of-bedside-pancreatic-scores-and-c-reactive-protein-in-predicting-pancreatic-fluid-collections-and-necrosis
#4
Doraiswami Babu Vinish, Vishnu Abishek, K Sujatha, S Arulprakash, Rajkumar Solomon, P Ganesh
BACKGROUND: Acute pancreatitis is a disease with variable outcome; the course of the disease can be modified by early aggressive management in patients with severe pancreatitis. Easily calculable pancreatic scores and investigations can help to triage these patients. We aimed to determine the role of bedside index for severity in acute pancreatitis (BISAP), harmless acute pancreatitis score (HAPS), and systemic inflammatory response syndrome (SIRS) scores on day of admission and C-reactive protein (CRP) at 48 h for predicting the presence of pancreatic fluid collection (PFC) and necrosis on CT scans done at 72 h...
February 9, 2017: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
https://www.readbyqxmd.com/read/28177940/emergency-department-pain-management-in-children-with-appendicitis-in-a-bi-ethnic-population
#5
Ron Jacob, Baruch Krauss, Gal Twito, Ronit Leiba, Itai Shavit
OBJECTIVES: Our goal was to examine factors associated with the administration of ED analgesia (any analgesia, opioid analgesia) in patients with acute appendicitis in a tertiary children's hospital in Israel, and to examine ethnic differences. METHODS: A retrospective cohort study of children evaluated in the ED, who had ICD-9 diagnosis of acute appendicitis. Regression analysis was used to test the effect of multiple variables on the provision of analgesia. Medications were administered according to a nurse-driven pain protocol...
February 7, 2017: Clinical Journal of Pain
https://www.readbyqxmd.com/read/28177169/emergency-department-triage-of-traumatic-head-injury-using-brain-electrical-activity-biomarkers-a-multisite-prospective-observational-validation-trial
#6
Daniel Hanley, Leslie S Prichep, Jeffrey Bazarian, J Stephen Huff, Rosanne Naunheim, John Garrett, Elizabeth Jones, David Wright, John O'Neill, Neeraj Badjatia, Dheeraj Gandhi, Kenneth C Curley, Richard Chiacchierini, Brian O'Neil, Dallas C Hack
OBJECTIVES: A brain electrical activity biomarker for identifying traumatic brain injury (TBI) in Emergency Department (ED) patients presenting with high GCS after sustaining a head injury has shown promise for objective, rapid, triage. The main objective of this study was to prospectively evaluate the efficacy of an automated classification algorithm to determine the likelihood of being CT positive, in high functioning TBI patients in the acute state. METHODS: Adult patients admitted to the ED for evaluation within 72 hours of sustaining a closed head injury with GCS 12-15were candidates for study...
February 8, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28173749/testing-a-systematic-approach-to-identify-and-prioritise-barriers-to-successful-implementation-of-a-complex-healthcare-intervention
#7
Louise E Craig, Leonid Churilov, Liudmyla Olenko, Dominique A Cadilhac, Rohan Grimley, Simeon Dale, Cintia Martinez-Garduno, Elizabeth McInnes, Julie Considine, Jeremy M Grimshaw, Sandy Middleton
BACKGROUND: Multiple barriers may inhibit the adoption of clinical interventions and impede successful implementation. Use of standardised methods to prioritise barriers to target when selecting implementation interventions is an understudied area of implementation research. The aim of this study was to describe a method to identify and prioritise barriers to the implementation of clinical practice elements which were used to inform the development of the T(3) trial implementation intervention (Triage, Treatment [thrombolysis administration; monitoring and management of temperature, blood glucose levels, and swallowing difficulties] and Transfer of stroke patients from Emergency Departments [ED])...
February 7, 2017: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/28165757/cerebral-regions-preserved-by-successful-endovascular-recanalization-of-acute-m1-segment-occlusions-a-voxel-based-analysis
#8
Seyedmehdi Payabvash, Shayandokht Taleb, Adnan I Qureshi
OBJECTIVES: To identify cerebral regions preserved by successful recanalization of middle cerebral artery (MCA) M1 segment, and their association with early clinical outcome. METHODS: Forty-seven patients who underwent endovascular treatment for acute unilateral M1 segment occlusion were included. Successful recanalization was defined by a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b/3. Final infarct volumes were segmented on follow-up MRI/CT, 2-7 days post symptom onset...
February 6, 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/28128223/neutrophil-gelatinase-associated-lipocalin-ngal-fails-as-an-early-predictor-of-contrast-induced-nephropathy-in-chronic-kidney-disease-anti-ci-aki-study
#9
Werner Ribitsch, Gernot Schilcher, Franz Quehenberger, Stefan Pilz, Rupert H Portugaller, Martini Truschnig-Wilders, Robert Zweiker, Marianne Brodmann, Philipp Stiegler, Alexander R Rosenkranz, John W Pickering, Joerg H Horina
: The aim of the study was to evaluate the diagnostic accuracy of urinary neutrophil gelatinase- associated lipocalin (uNGAL) in patients with chronic kidney disease (CKD) as an early biomarker for contrast induced acute kidney injury (CI-AKI) and to investigate whether patients with an uNGAL increase might benefit from an additional intravenous volume expansion with regard to CI-AKI-incidence. We performed a prospective randomized controlled trial in 617 CKD-patients undergoing intra-arterial angiography...
January 27, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28127121/interpretation-of-positive-troponin-results-among-patients-with-and-without-myocardial-infarction
#10
Kristen M Tecson, William Arnold, Tyler Barrett, Robert Birkhahn, Lori B Daniels, Christopher DeFilippi, Gary Headden, W Frank Peacock, Michael Reed, Adam J Singer, Jeffrey M Schussler, Stephen Smith, Martin P Than, Peter A McCullough
Measuring cardiac troponins is integral to diagnosing acute myocardial infarction (AMI); however, troponins may be elevated without AMI, and the use of multiple different assays confounds comparisons. We considered characteristics and serial troponin values in emergency department chest pain patients with and without AMI to interpret troponin excursions. We compared serial troponin in 124 AMI and non-AMI patients from the observational Performance of Triage Cardiac Markers in the Clinical Setting (PEARL) study who presented with chest pain and had at least one troponin value exceeding the 99th percentile of normal...
January 2017: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/28125855/predictors-and-outcomes-of-acute-pancreatitis-in-critically-ill-patients-presenting-to-the-emergency-department-of-a-tertiary-referral-centre-in-australia
#11
Krishnaswamy Sundararajan, Tom Schoeman, Lara Hughes, Suzanne Edwards, Benjamin Reddi
OBJECTIVE: To provide a current review of the clinical characteristics, predictors and outcomes in critically ill patients presenting to the ED with acute pancreatitis and subsequently admitted to an intensive care unit (ICU) of a tertiary referral centre in Australia. METHODS: A retrospective single-centre study of adult patients admitted with pancreatitis. Severe acute pancreatitis defined by Bedside Index of Severity in Acute Pancreatitis (BISAP) score ≥2. RESULTS: Eighty-seven patients fulfilled criteria for inclusion during the study period, representing 0...
January 26, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28116006/development-of-an-assessment-for-entrustable-professional-activity-epa-10-emergent-patient-management
#12
Laura R Thompson, Cynthia G Leung, Brad Green, Jonathan Lipps, Troy Schaffernocker, Cynthia Ledford, John Davis, David P Way, Nicholas E Kman
INTRODUCTION: Medical schools in the United States are encouraged to prepare and certify the entrustment of medical students to perform 13 core entrustable professional activities (EPAs) prior to graduation. Entrustment is defined as the informed belief that the learner is qualified to autonomously perform specific patient-care activities. Core EPA-10 is the entrustment of a graduate to care for the emergent patient. The purpose of this project was to design a realistic performance assessment method for evaluating fourth-year medical students on EPA-10...
January 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28111748/trauma-care-in-a-combined-rural-and-urban-region-an-observational-study
#13
O Uleberg, T Kristiansen, K Pape, P R Romundstad, P Klepstad
BACKGROUND: The available information on trauma care in mixed rural-urban areas with scattered populations is limited. The aim of this study is to describe epidemiology, resource use, transfers and outcomes for trauma care within such an area, prior to implementation of a formal trauma system. METHODS: A multicentre observational study including potential severely injured patients from June 2007 to May 2010. All patients received by trauma teams at seven acute care hospitals (ACH) and one major trauma centre (MTC) were included...
March 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28107026/impact-of-mobile-intensive-care-unit-use-on-total-ischemic-time-and-clinical-outcomes-in-st-elevation-myocardial-infarction-patients-real-world-data-from-the-acute-coronary-syndrome-israeli-survey
#14
Edward Koifman, Roy Beigel, Zaza Iakobishvili, Nir Shlomo, Yitschak Biton, Avi Sabbag, Elad Asher, Shaul Atar, Shmuel Gottlieb, Ronny Alcalai, Doron Zahger, Amit Segev, Ilan Goldenberg, Rafael Strugo, Shlomi Matetzky
BACKGROUND: Ischemic time has prognostic importance in ST-elevation myocardial infarction patients. Mobile intensive care unit use can reduce components of total ischemic time by appropriate triage of ST-elevation myocardial infarction patients. METHODS: Data from the Acute Coronary Survey in Israel registry 2000-2010 were analyzed to evaluate factors associated with mobile intensive care unit use and its impact on total ischemic time and patient outcomes. RESULTS: The study comprised 5474 ST-elevation myocardial infarction patients enrolled in the Acute Coronary Survey in Israel registry, of whom 46% ( n=2538) arrived via mobile intensive care units...
January 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28104707/improving-care-standards-for-patients-with-spinal-trauma-combining-a-modified-e-delphi-process-and-stakeholder-interviews-a-study-protocol
#15
Lisa N Sharwood, Ralph Stanford, James W Middleton, Brian Burns, Anthony Joseph, Oliver Flower, Oran Rigby, Jonathon Ball, Shelly Dhaliwal
INTRODUCTION: Around 300 people sustain a new traumatic spinal cord injury (TSCI) in Australia each year; a relatively low incidence injury with extremely high long-term associated costs. Care standards are inconsistent nationally, lacking in consensus across important components of care such as prehospital spinal immobilisation, timing of surgery and timeliness of transfer to specialist services. This study aims to develop 'expertly defined' and agreed standards of care across the majority of disciplines involved for these patients...
January 19, 2017: BMJ Open
https://www.readbyqxmd.com/read/28103892/prehospital-intravenous-fentanyl-to-patients-with-hip-fracture-an-observational-cohort-study-of-risk-factors-for-analgesic-non-treatment
#16
Kristian D Friesgaard, Erika F Christensen, Hans Kirkegaard, Mette D Bendtsen, Flemming B Jensen, Lone Nikolajsen
BACKGROUND: Patients with proximal femoral neck fracture have a high short-term mortality, a high risk of postoperative complications, and impaired quality of life. One of the challenges related to the prehospital treatment of these patients is to administer systemic opioids fast and properly. Effective analgesic prehospital treatment ought be initiated rapidly in order to alleviate the stress that follows acute pain, to facilitate transportation, and to improve quality of care. The objectives of this study were to explore the prevalence of prehospital administration of intravenous fentanyl to patients with proximal femoral neck fracture in the ambulances and to assess risk factors for analgesic non-treatment...
January 19, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28095408/patient-safety-incidents-involving-sick-children-in-primary-care-in-england-and-wales-a-mixed-methods-analysis
#17
Philippa Rees, Adrian Edwards, Colin Powell, Peter Hibbert, Huw Williams, Meredith Makeham, Ben Carter, Donna Luff, Gareth Parry, Anthony Avery, Aziz Sheikh, Liam Donaldson, Andrew Carson-Stevens
BACKGROUND: The UK performs poorly relative to other economically developed countries on numerous indicators of care quality for children. The contribution of iatrogenic harm to these outcomes is unclear. As primary care is the first point of healthcare contact for most children, we sought to investigate the safety of care provided to children in this setting. METHODS AND FINDINGS: We undertook a mixed methods investigation of reports of primary care patient safety incidents involving sick children from England and Wales' National Reporting and Learning System between 1 January 2005 and 1 December 2013...
January 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28089154/pre-hospital-electrocardiogram-triage-with-telemedicine-near-halves-time-to-treatment-in-stemi-a-meta-analysis-and-meta-regression-analysis-of-non-randomized-studies
#18
REVIEW
Natale Daniele Brunetti, Luisa De Gennaro, Michele Correale, Francesco Santoro, Pasquale Caldarola, Antonio Gaglione, Matteo Di Biase
BACKGROUND: A shorter time to treatment has been shown to be associated with lower mortality rates in acute myocardial infarction (AMI). Several strategies have been adopted with the aim to reduce any delay in diagnosis of AMI: pre-hospital triage with telemedicine is one of such strategies. We therefore aimed to measure the real effect of pre-hospital triage with telemedicine in case of AMI in a meta-analysis study. METHODS: We performed a meta-analysis of non-randomized studies with the aim to quantify the exact reduction of time to treatment achieved by pre-hospital triage with telemedicine...
January 8, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28062332/psychosocial-concerns-in-the-postoperative-oncology-patient
#19
REVIEW
Elizabeth Ercolano
OBJECTIVES: To describe psychosocial concerns associated with the postoperative cancer patient and to discuss current psychosocial evidence-based approaches to manage these psychosocial concerns. DATA SOURCES: Published peer-reviewed literature. CONCLUSION: The postoperative phase of cancer care may be associated with a range of overlapping acute and chronic psychosocial concerns related to the surgery itself, the cancer diagnosis, and the need for ongoing cancer treatments...
February 2017: Seminars in Oncology Nursing
https://www.readbyqxmd.com/read/28059860/diagnosis-and-treatment-of-upper-airway-oedema-caused-by-acute-angio-oedema-in-the-emergency-department-a-french-consensus-statement
#20
Bernard Floccard, Nicolas Javaud, Alban Deroux, Isabelle Boccon-Gibod, Olivier Fain, Stéphanie Amarger, Claire Blanchard-Delaunay, Pierre Y Jeandel, Nicolas Marmion, Yann Ollivier, Pauline Pralong, Stéphane Gayet, Aurélie Du-Thanh, Fabien Pelletier, Laurent Sailler, Philip Robinson, David Launay, Laurence Bouillet
Angio-oedema is a transitory, localized, noninflammatory oedema of subcutaneous tissue or mucous. When the oedema affects the mouth, lips, tongue or larynx, it can result in fatal asphyxiation in the absence of specific treatment. Oedema secondary to plasma extravasation is usually mediated by either histamine or bradykinin. As laboratory tests are not available in an emergency setting, the implicated mediator cannot be readily determined. The challenge for the emergency physician is to determine the aetiological type, evaluate severity and initiate adapted treatment by means of a structured approach...
January 4, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
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