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Emergency Triage

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https://www.readbyqxmd.com/read/29143448/prospective-observational-study-of-predicted-usage-of-intravenous-cannulas-inserted-in-a-tertiary-paediatric-emergency-department
#1
William Hollaway, Carsten Broeze, Meredith L Borland
OBJECTIVES: To determine the proportion of unused peripheral intravenous cannulas (PIVCs) inserted in a paediatric emergency department (PED) and to assess clinicians' abilities to predict future usage of PIVC. METHODS: Prospective concealed observational study in a tertiary PED. Healthcare workers (HCWs) completed questionnaires upon insertion and removal of PIVC with review of patient notes if required. The primary outcome was the number of unused, unnecessary PIVCs...
November 16, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29140107/a-cross-sectional-study-of-ethnicity-based-differences-in-treatment-seeking-for-symptoms-of-acute-coronary-syndrome
#2
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/29137902/effects-of-opioid-medications-on-cognitive-skills-among-emergency-department-patients
#3
Catherine A Marco, Dennis Mann, Jordan Rasp, Michael Ballester, Oswald Perkins, Michael B Holbrook, Kyle Rako
INTRODUCTION: Treatment for pain and related conditions has been identified as the most common reason for Emergency Department (ED) visits. Concerns exist regarding the effects of opioid pain medications on cognition and patient ability to consent for procedures, hospital admission, or to refuse recommended medical interventions. This study was undertaken to identify cognitive skills before and after opioid pain medication in the ED setting. METHODS: This was a prospective study comparing performance on the Mini-Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA) before and after administration of opioid pain medications...
November 8, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29137611/diagnostic-validity-and-triage-concordance-of-a-physiotherapist-compared-to-physicians-diagnoses-for-common-knee-disorders
#4
S Décary, M Fallaha, B Pelletier, P Frémont, J Martel-Pelletier, J-P Pelletier, D E Feldman, M-P Sylvestre, P-A Vendittoli, F Desmeules
BACKGROUND: Emergence of more autonomous roles for physiotherapists warrants more evidence regarding their diagnostic capabilities. Therefore, we aimed to evaluate diagnostic and surgical triage concordance between a physiotherapist and expert physicians and to assess the diagnostic validity of the physiotherapist's musculoskeletal examination (ME) without imaging. METHODS: This is a prospective diagnostic study where 179 consecutive participants consulting for any knee complaint were independently diagnosed and triaged by two evaluators: a physiotherapist and one expert physician (orthopaedic surgeons or sport medicine physicians)...
November 14, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/29136270/60-seconds-to-survival-a-pilot-study-of-a-disaster-triage-video-game-for-prehospital-providers
#5
Mark X Cicero, Travis Whitfill, Kevin Munjal, Manu Madhok, Maria Carmen G Diaz, Daniel J Scherzer, Barbara M Walsh, Angela Bowen, Michael Redlener, Scott A Goldberg, Nadine Symons, James Burkett, Joseph C Santos, David Kessler, Ryan N Barnicle, Geno Paesano, Marc A Auerbach
INTRODUCTION: Disaster triage training for emergency medical service (EMS) providers is not standardized. Simulation training is costly and time-consuming. In contrast, educational video games enable low-cost and more time-efficient standardized training. We hypothesized that players of the video game "60 Seconds to Survival" (60S) would have greater improvements in disaster triage accuracy compared to control subjects who did not play 60S. METHODS: Participants recorded their demographics and highest EMS training level and were randomized to play 60S (intervention) or serve as controls...
April 2017: American Journal of Disaster Medicine
https://www.readbyqxmd.com/read/29135904/patient-factors-associated-with-the-decision-to-transfer-adult-patients-from-a-pediatric-emergency-department-for-definitive-care
#6
Aaron E Kornblith, Ashley A Foster, Christine S Cho, Ralph C Wang, David M Jaffe
OBJECTIVE: Adults presenting to pediatric emergency departments are transferred to general emergency departments in proportions between 20% and 60%. How illness severity is related to the decision to transfer is poorly understood. We compared the proportion of adults with emergent and nonemergent conditions with respect to their final disposition. We also determined characteristics associated with transfer. METHODS: We conducted a retrospective review of the electronic medical record and identified all patients 25 years and older presenting to a large urban freestanding pediatric emergency department from 2008 to 2013...
November 14, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29133262/911-emergency-medical-services-and-re-triage-to-level-i-trauma-centers
#7
Eric Kuncir, Dean Spencer, Kelly Feldman, Cristobal Barrios, Kenneth Miller, Stephanie Lush, Matthew Dolich, Michael Lekawa
BACKGROUND: Interfacility transfer of under-triaged patients to higher level trauma centers has been found to result in a delay of appropriate care and increase in mortality. To address this, for the last 10 years, our region has utilized 911 EMS paramedics for rapid re-triage of under-triaged patients to our institution's Level I trauma center. We sought to determine if utilizing 911 EMS for re-triage (911-RT) to our institution was associated with worse outcomes-with mortality as the primary outcome-compared to direct EMS transport from point of injury...
September 27, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29131324/advanced-imaging-reduces-cost-compared-to-standard-of-care-in-emergency-department-of-triage-of-acute-chest-pain
#8
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
#9
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/29129717/a-chemoproteomic-approach-to-query-the-degradable-kinome-using-a-multi-kinase-degrader
#10
Hai-Tsang Huang, Dennis Dobrovolsky, Joshiawa Paulk, Guang Yang, Ellen L Weisberg, Zainab M Doctor, Dennis L Buckley, Joong-Heui Cho, Eunhwa Ko, Jaebong Jang, Kun Shi, Hwan Geun Choi, James D Griffin, Ying Li, Steven P Treon, Eric S Fischer, James E Bradner, Li Tan, Nathanael S Gray
Heterobifunctional molecules that recruit E3 ubiquitin ligases, such as cereblon, for targeted protein degradation represent an emerging pharmacological strategy. A major unanswered question is how generally applicable this strategy is to all protein targets. In this study, we designed a multi-kinase degrader by conjugating a highly promiscuous kinase inhibitor with a cereblon-binding ligand, and used quantitative proteomics to discover 28 kinases, including BTK, PTK2, PTK2B, FLT3, AURKA, AURKB, TEC, ULK1, ITK, and nine members of the CDK family, as degradable...
November 7, 2017: Cell Chemical Biology
https://www.readbyqxmd.com/read/29128034/use-of-extracorporeal-membrane-oxygenation-and-surgical-embolectomy-for-massive-pulmonary-embolism-in-the-emergency-department
#11
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/29126459/emergency-department-waiting-times-in-a-tertiary-children-s-hospital-in-israel-a-retrospective-cohort-study
#12
Oren Feldman, Raviv Allon, Ronit Leiba, Itai Shavit
BACKGROUND: The purpose of this study was to assess ethnic differences in Emergency Department (ED) waiting times between Jewish and Arab children in a tertiary childrens' hospital in Israel. METHODS: This was a retrospective cohort study of all children who were admitted to the pediatric ED of the largest hospital in northern Israel, between January 2011 and December 2015. Univariate and multivariate analyses were used to assess the strength of association between ethnicity category and waiting time...
November 10, 2017: Israel Journal of Health Policy Research
https://www.readbyqxmd.com/read/29123873/a-study-of-the-effect-of-introduction-of-jtas-in-the-emergency-room
#13
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
#14
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/29123603/paediatric-appropriate-facilities-in-emergency-departments-of-community-hospitals-in-ontario-a-cross-sectional-study
#15
Muhammad Akhter Hamid, Sohaib Siddiqui, Jabeen Fayyaz, Ayesha Chandna, Aliya Ariz, Joe Butchey, Elancheliyan Ambalavanar, Niraj Mistry, Aftab Muhammad Azad, Junaid A Bhatti, Dennis Scolnik
BACKGROUND: We assessed whether the paediatric-appropriate facilities were available at Emergency Departments (ED) in community hospitals in a Canadian province. METHODS: We conducted a cross-sectional survey of EDs in community hospitals in Ontario, Canada that had inpatient paediatric facilities and a neonatal intensive care unit. Key informants were ED chiefs, clinical educators, or managers. The survey included questions about paediatric facilities related to environment, triage, training, and staff in EDs...
2017: World Journal of Emergency Medicine
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
#16
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/29117454/factors-affecting-quality-of-nurse-shift-handover-in-the-emergency-department
#17
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/29116997/hospital-differences-drive-antibiotic-delays-for-black-patients-compared-with-white-patients-with-suspected-septic-shock
#18
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/29115767/care-delays-in-patients-with-signs-and-symptoms-of-acute-myocardial-infarction
#19
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/29105064/outcomes-after-cancelled-helicopter-emergency-medical-service-missions-due-to-concurrencies-a-retrospective-cohort-study
#20
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
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