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Acute Triage

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https://www.readbyqxmd.com/read/29140107/a-cross-sectional-study-of-ethnicity-based-differences-in-treatment-seeking-for-symptoms-of-acute-coronary-syndrome
#1
Emma Iacoe, Pamela A Ratner, Sabrina T Wong, Martha H Mackay
BACKGROUND: Patient-related delays in acquiring medical care for symptoms of acute coronary syndrome remain unacceptably long. Many clinical and sociodemographic characteristics associated with treatment-seeking delay are known; however, ethnicity has not been extensively evaluated. OBJECTIVE: The purpose of this study was to examine ethnicity-based differences in the time-to-treatment-seeking intervals of patients experiencing symptoms of acute coronary syndrome...
November 1, 2017: European Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/29132575/acute-management-of-the-traumatically-injured-pelvis
#2
REVIEW
Steven Skitch, Paul T Engels
Severe pelvic trauma is a challenging condition. The pelvis can create multifocal hemorrhage that is not easily compressible nor managed by traditional surgical methods such as tying off a blood vessel or removing an organ. Its treatment often requires reapproximation of bony structures, damage control resuscitation, assessment for associated injuries, and triage of investigations, as well as multimodality hemorrhage control (external fixation, preperitoneal packing, angioembolization, REBOA [resuscitative endovascular balloon occlusion of the aorta]) by multidisciplinary trauma specialists (general surgeons, orthopedic surgeons, endovascular surgeons/interventional radiologists)...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29131768/from-inguinal-hernias-to-spermatic-cord-lipomas-pearls-pitfalls-and-mimics-of-abdominal-and-pelvic-hernias
#3
Miguel C Cabarrus, Benjamin M Yeh, Andrew S Phelps, Jao J Ou, Spencer C Behr
Abdominal and pelvic hernias may be indolent and detected incidentally, manifest acutely with pain and distress, or cause chronic discomfort. Physical examination findings are often ambiguous and insufficient for optimal triage. Therefore, accurate anatomic delineation and identification of complications are critical for effective treatment planning. Imaging, particularly computed tomography, provides a vital understanding of the hernia's location and size, involved viscera, and severity of associated complications...
November 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/29131324/advanced-imaging-reduces-cost-compared-to-standard-of-care-in-emergency-department-of-triage-of-acute-chest-pain
#4
Pamela S Noack, Jhanna A Moore, Michael Poon
OBJECTIVE: To evaluate medical costs of novel therapies in complex medical settings using registry data. DATA SOURCE/STUDY SETTING: Primary data, from 2008 to 2010. We used patient registry data to evaluate cost and quality performance of coronary computed tomography angiography (CCTA) in triaging chest pain patients in our tertiary care emergency department and to model financial performance under Medicare's two midnight rule. STUDY DESIGN: Using generalized linear modeling, we retrospectively compared estimated expenditures for evaluation of low-to-intermediate-risk chest pain for demographic and medically risk matched samples of 894 patients each, triaged with CCTA or local standard of care (SOC) using Medicare reimbursement as a proxy...
November 13, 2017: Health Services Research
https://www.readbyqxmd.com/read/29130951/prehospital-computed-tomography-angiography-in-acute-stroke-management
#5
Michael Kettner, Stefan Alexander Helwig, Andreas Ragoschke-Schumm, Lenka Schwindling, Safwan Roumia, Isabel Keller, Daniel Martens, Johann Kulikovski, Matthias Manitz, Martin Lesmeister, Silke Walter, Iris Quasar Grunwald, Thomas Schlechtriemen, Wolfgang Reith, Klaus Fassbender
BACKGROUND: An ambulance equipped with a computed tomography (CT) scanner, a point-of-care laboratory, and telemedicine capabilities (mobile stroke unit [MSU]) has been shown to enable the delivery of thrombolysis to stroke patients directly at the emergency site, thereby significantly decreasing time to treatment. However, work-up in an MSU that includes CT angiography (CTA) may also potentially facilitate triage of patients directly to the appropriate target hospital and specialized treatment, according to their individual vascular pathology...
October 31, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29128034/use-of-extracorporeal-membrane-oxygenation-and-surgical-embolectomy-for-massive-pulmonary-embolism-in-the-emergency-department
#6
De Ante Russ, Nicole Payne, Mark Bonnell, Viviane Kazan
BACKGROUND: Massive pulmonary embolism (PE) carries significant morbidity and mortality with current standard of care modalities. CASE REPORT: We present the case of a 63-year-old male status post abdominal surgery 2 weeks before presenting to the emergency department with a massive pulmonary embolism and subsequent acute cardiopulmonary failure. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Here we describe a case of extracorporeal membrane oxygenation (ECMO) deployed in the emergency department as a bridge to embolectomy to successfully treat massive pulmonary embolism...
November 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29123873/a-study-of-the-effect-of-introduction-of-jtas-in-the-emergency-room
#7
Toru Koyama, Takeshi Kashima, Motoyoshi Yamamoto, Kenjiro Ouchi, Takayuki Kotoku, Yuta Mizuno
Aim: The purpose of this study was to better understand the effects of introducing the Japan Triage and Acuity Scale (JTAS) in the emergency room for walk-in patients. Methods: A simple triage was used in Term A (from April 2006 to December 2010, 4 years and 9 months) and the JTAS was introduced in Term B (from January 2011 to September 2015, 4 years and 9 months). The number of patients who had a sudden turn for the worse after arrival in the emergency room and the time between attendance and emergency catheterization (TBAEC) due to acute coronary syndrome were reviewed...
July 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29123838/prehospital-triage-for-endovascular-clot-removal-in-acute-stroke-patients
#8
Yu Suzuki, Yasuhiro Hasegawa, Kohtaro Tsumura, Toshihiro Ueda, Kazunari Suzuki, Makoto Sugiyama, Hiroyuki Nozaki, Shojiro Kawaguchi, Makoto Nakane, Goro Nagashima, Takayuki Kitamura, Kengo Yokomine, Jinichi Sasanuma
Aim: To establish prehospital triage in accordance with the new guidelines for endovascular therapy, we retrospectively analyzed the monitoring data of the city-wide transportation system using the Maria Prehospital Stroke Scale (MPSS), a novel prehospital stroke scale for emergency medical technicians (EMTs) to predict the likelihood of thrombolytic therapy after transportation. Methods: Kawasaki City, Japan, has six comprehensive stroke centers (CSCs) and six primary stroke centers (PSCs)...
January 2017: Acute Medicine & Surgery
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
#9
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/29120036/rapid-assessment-with-physical-examination-in-dyspnoeic-cats-the-rapid-cat-study
#10
D Dickson, C J L Little, J Harris, M Rishniw
OBJECTIVES: To determine the underlying disease prevalence in acute feline dyspnoea and to examine whether historical and clinical examination findings can differentiate between acute cardiac and non-cardiac dyspnoea in cats in primary practice. MATERIALS AND METHODS: We prospectively enrolled cats presenting with dyspnoea for the first time to primary practice between June 1, 2011 and October 31, 2016. We collected signalment, historical and clinical data at presentation using a standard form...
November 9, 2017: Journal of Small Animal Practice
https://www.readbyqxmd.com/read/29119876/endovascular-treatment-outcomes-using-the-stroke-triage-education-procedure-standardization-and-technology-steps-t-program
#11
Ameer E Hassan, Christina Sanchez, Angela N Johnson
Background "Door to treatment" time affects outcomes of acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). However, the correlation between staff education and accessible technology with stroke outcomes has not been demonstrated. Objective The objective of this paper is to demonstrate the five-year impact of the Stroke Triage Education, Procedure Standardization, and Technology (STEPS-T) program on time-to-treat and clinical outcomes. Methods The study analyzed a prospectively maintained database of AIS patients who benefited from EVT through implementation of STEPS-T...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29115767/care-delays-in-patients-with-signs-and-symptoms-of-acute-myocardial-infarction
#12
Susan Sanders
AIM: More than six million patients with signs and symptoms suggestive of a heart attack present to emergency departments (EDs) in the US each year. Of those diagnosed with acute myocardial infarction (AMI), one third die in the acute phase. Rapid ED triage can reduce the mortality rate, yet there are still delays in patient care. The aim of this study is to explore the relationship between patient and nurse characteristics, patient presentations, delays in triage, and delays in obtaining electrocardiograms (ECGs) of patients with signs and symptoms of AMI...
October 12, 2017: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/29113999/index-of-microcirculatory-resistance-at-the-time-of-primary-percutaneous-coronary-intervention-predicts-early-cardiac-complications-insights-from-the-oxami-oxford-study-in-acute-myocardial-infarction-cohort
#13
Gregor Fahrni, Mathias Wolfrum, Giovanni Luigi De Maria, Florim Cuculi, Sam Dawkins, Mohammad Alkhalil, Niket Patel, John C Forfar, Bernard D Prendergast, Robin P Choudhury, Keith M Channon, Adrian P Banning, Rajesh K Kharbanda
BACKGROUND: Early risk stratification after primary percutaneous coronary intervention (PPCI) for ST-segment-elevation myocardial infarction is currently challenging. Identification of a low-risk group may improve triage of patients to alternative clinical pathways and support early hospital discharge. Our aim was to assess whether the index of microcirculatory resistance (IMR) at the time of PPCI can identify patients at low risk of early major cardiac complications and to compare its performance against guideline-recommended risk scores...
November 7, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29105064/outcomes-after-cancelled-helicopter-emergency-medical-service-missions-due-to-concurrencies-a-retrospective-cohort-study
#14
Ø Østerås, J-K Heltne, K Tønsager, G Brattebø
BACKGROUND: Appropriate dispatch criteria and helicopter emergency medical service (HEMS) crew decisions are crucial for avoiding over-triage and reducing the number of concurrencies. The aim of the present study was to compare patient outcomes after completed HEMS missions and missions cancelled by the HEMS due to concurrencies. METHODS: Missions cancelled due to concurrencies (AMB group) and completed HEMS missions (HEMS group) in Western Norway from 2004 to 2013 were assessed...
November 3, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29105063/distinguishing-characteristics-of-headache-in-nontraumatic-subarachnoid-hemorrhage
#15
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/29102289/in-hospital-mortality-analysis-of-japanese-patients-with-acute-coronary-syndrome-using-the-tokyo-ccu-network-database-applicability-of-the-grace-risk-score
#16
Kota Komiyama, Masato Nakamura, Kengo Tanabe, Hiroki Niikura, Hajime Fujimoto, Keiko Oikawa, Hiroyuki Daida, Takeshi Yamamoto, Ken Nagao, Morimasa Takayama
BACKGROUND: The GRACE risk score was developed to predict in-hospital mortality for acute coronary syndrome (ACS) using multinational registries, but did not include Japanese data. Therefore, GRACE risk scores are not extensively used in Japan. The present study aimed to evaluate the relationship between the GRACE risk score and in-hospital mortality among Japanese patients with ACS using the Tokyo CCU (cardiovascular care unit) Network Database. METHODS AND RESULTS: A total of 9460 patients with ACS hospitalized at 67 Tokyo CCUs between January 2011 and December 2013 were retrospectively reviewed and GRACE risk scores were calculated...
October 25, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/29072885/cardiopulmonary-ultrasound-for-critically-ill-adults-improves-diagnostic-accuracy-in-a-resource-limited-setting-the-africa-trial
#17
Torben K Becker, Chelsea A Tafoya, Maxwell Osei-Ampofo, Matthew J Tafoya, Ross A Kessler, Nikhil Theyyunni, Hussein A Yakubu, Daniel Opuni, Daniel J Clauw, James A Cranford, Chris K Oppong, Rockefeller A Oteng
OBJECTIVE: To assess the effects of a cardiopulmonary ultrasound (CPUS) examination on diagnostic accuracy for critically ill patients in a resource-limited setting. METHODS: Approximately half of the emergency medicine resident physicians at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, were trained in a CPUS protocol. Adult patients triaged to the resuscitation area of the emergency department (ED) were enrolled if they exhibited signs or symptoms of shock or respiratory distress...
October 26, 2017: Tropical Medicine & International Health: TM & IH
https://www.readbyqxmd.com/read/29072867/measuring-impact-of-telephone-triage-in-acute-medicine
#18
Huma Asmat, Shah Khalid Shinwari, Tim Cooksley, Roger Duckitt, Ivan Le Jeune, Christian P Subbe
The Society for Acute Medicine's Benchmarking Audit (SAMBA) was undertaken for the 5th time in June 2016. For the first time, data on telephone triage calls prior to admission to Acute Medical Units were collected: 1238 patients were referred from Emergency Departments, 925 from General Practitioners (GPs), 52 from clinics and 147 from other sources. Calls from Emergency Departments rarely resulted in admission avoidance. Calls from Primary Care resulted in avoidance of an admission in 115 (12%) patients; the percentage of avoided admissions was highest if the call was taken by a Consultant...
2017: Acute Medicine
https://www.readbyqxmd.com/read/29070716/plumber-study-prevalence-of-large-vessel-occlusion-strokes-in-mecklenburg-county-emergency-response
#19
Adeline Dozois, Lorrie Hampton, Carlene W Kingston, Gwen Lambert, Thomas J Porcelli, Denise Sorenson, Megan Templin, Shellie VonCannon, Andrew W Asimos
BACKGROUND AND PURPOSE: The recently proposed American Heart Association/American Stroke Association EMS triage algorithm endorses routing patients with suspected large vessel occlusion (LVO) acute ischemic strokes directly to endovascular centers based on a stroke severity score. The predictive value of this algorithm for identifying LVO is dependent on the overall prevalence of LVO acute ischemic stroke in the EMS population screened for stroke, which has not been reported. METHODS: We performed a cross-sectional study of patients transported by our county's EMS agency who were dispatched as a possible stroke or had a primary impression of stroke by paramedics...
October 25, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29064258/new-or-presumed-new-left-bundle-branch-block-in-patients-with-suspected-st-elevation-myocardial-infarction
#20
Vijaya K Pera, David M Larson, Scott W Sharkey, Ross F Garberich, Christopher J Solie, Yale L Wang, Jay H Traverse, Anil K Poulose, Timothy D Henry
AIMS: Using a comprehensive large prospective regional ST-elevation myocardial infarction (STEMI) system database, we evaluated the prevalence, clinical and angiographic characteristics, and outcomes in patients with ischemic symptoms and new or presumed new left bundle branch block (LBBB). We then tested a new hierarchical diagnosis and triage algorithm to identify more accurately new LBBB patients with an acute culprit lesion. METHODS AND RESULTS: From March 2003 to June 2013, 3903 consecutive STEMI patients were treated using the Minneapolis Heart Institute regional STEMI protocol including 131 patients (3...
February 1, 2017: European Heart Journal. Acute Cardiovascular Care
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