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Emergency department operations

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https://www.readbyqxmd.com/read/29331493/hip-dislocations-in-the-emergency-department-a-review-of-reduction-techniques
#1
Michael Gottlieb
BACKGROUND: Hip dislocations are a common presentation in the Emergency Department (ED) and require urgent reduction to reduce the risk of avascular necrosis. Over 90% of all dislocations can successfully be reduced in the ED and there is evidence that cases awaiting operative reduction result in significant delays. DISCUSSION: While there is limited data comparing specific techniques, the individual success rates of most maneuvers range from 60-90%. Additionally, each technique has distinct advantages and limitations associated with its use...
January 10, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29331271/the-durability-of-operational-improvements-with-rotational-patient-assignment
#2
Stephen J Traub, Soroush Saghafian, Adam C Bartley, Matthew R Buras, Christopher F Stewart, Brian T Kruse
INTRODUCTION: Previous work has suggested that Emergency Department rotational patient assignment (a system in which patients are algorithmically assigned to physicians) is associated with immediate (first-year) improvements in operational metrics. We sought to determine if these improvements persisted over a longer follow-up period. METHODS: Single-site, retrospective analysis focused on years 2-4 post-implementation (follow-up) of a rotational patient assignment system...
December 20, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29327268/serum-thiol-levels-and-thiol-disulphide-homeostasis-in-gunshot-injuries
#3
Hasan Buyukaslan, Umut Gulacti, Mehmet Tahir Gökdemir, Ramazan Giden, Hakim Celik, Özcan Erel, Erman Mustafa Dörterler
BACKGROUND: Gunshot injuries result in serious traumatic tissue damage due to high velocity of the bullet, deep penetration, and ballistic effect. Trauma is known to be related with oxidative stress. Serum thiol levels and disulphide/thiol homeostasis are novel oxidative stress biomarkers. In this study, we aimed to investigate serum thiol levels and disulphide/thiol homeostasis in injury patterns of patients admitted to the emergency department with a gunshot injury. METHOD: A total of 128 participants were included in the study...
January 11, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29327150/levels-of-serum-uric-acid-at-admission-for-hypoglycaemia-predict-1-year-mortality
#4
Aldo Bonaventura, Fiorenza Gallo, Federico Carbone, Luca Liberale, Davide Maggi, Giovanni Sacchi, Franco Dallegri, Fabrizio Montecucco, Renzo Cordera
AIMS: Hypoglycaemia represents a critical burden with clinical and social consequences in the management of diabetes. Serum uric acid (SUA) has been associated with cardiovascular diseases (CVD), but no conclusive findings are available nowadays in patients suffering from hypoglycaemia. We investigated whether SUA levels at the time of hypoglycaemia could predict all-cause mortality after 1-year follow-up. METHODS: In total, 219 patients admitted to the Emergency Department (ED) of Ospedale Policlinico S...
January 11, 2018: Acta Diabetologica
https://www.readbyqxmd.com/read/29321117/emergency-department-resuscitation-of-pediatric-trauma-patients-in-iraq-and-afghanistan
#5
Steven G Schauer, Guyon J Hill, Jason F Naylor, Michael D April, Matthew Borgman, Vikhyat S Bebarta
BACKGROUND: Military hospital healthcare providers treated children during the recent conflicts in Afghanistan and Iraq. Compared to adults, pediatric patients present unique challenges during trauma resuscitations and have notably been discussed in few research reports. We seek to describe ED interventions performed on pediatric trauma patients in Iraq and Afghanistan. METHODS: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric patients in Iraq and Afghanistan from January 2007 to January 2016...
January 4, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29318084/how-does-frailty-factor-into-mortality-risk-assessment-of-a-middle-aged-and-geriatric-trauma-population
#6
Sanjit R Konda, Ariana Lott, Hesham Saleh, Sebastian Schubl, Jeffrey Chan, Kenneth A Egol
Introduction: Frailty in elderly trauma populations has been correlated with an increased risk of morbidity and mortality. The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is a validated mortality risk score that evaluates 4 major physiologic criteria: age, comorbidities, vital signs, and anatomic injuries. The aim of this study was to investigate whether the addition of additional frailty variables to the STTGMA tool would improve risk stratification of a middle-aged and elderly trauma population...
December 2017: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/29310983/applying-advanced-analytics-to-guide-emergency-department-operational-decisions-a-proof-of-concept-study-examining-the-effects-of-boarding
#7
R Andrew Taylor, Arjun Venkatesh, Vivek Parwani, Sharon Chekijian, Marc Shapiro, Andrew Oh, David Harriman, Asim Tarabar, Andrew Ulrich
BACKGROUND: Emergency Department (ED) leaders are increasingly confronted with large amounts of data with the potential to inform and guide operational decisions. Routine use of advanced analytic methods may provide additional insights. OBJECTIVES: To examine the practical application of available advanced analytic methods to guide operational decision making around patient boarding. METHODS: Retrospective analysis of the effect of boarding on ED operational metrics from a single site between 1/2015 and 1/2017...
January 4, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29310919/increased-complications-for-schizophrenia-and-bipolar-disorder-patients-undergoing-total-joint-arthroplasty
#8
Michael M Kheir, You Na P Kheir, Timothy L Tan, Colin T Ackerman, Alexander J Rondon, Antonia F Chen
BACKGROUND: Although it has been shown that anxiety and depression are associated with increased complications after total joint arthroplasty (TJA), the outcomes of TJA in patients with a history of psychosis are unknown. This study evaluated the influence of bipolar and schizophrenic disorders on complications after TJA, particularly aseptic and septic revisions. METHODS: A retrospective review of 156 TJAs (125 primaries and 31 revisions) was performed at a single institution from 2000 to 2015...
December 14, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29310365/ebv-lymphoproliferative-associated-disease-and-primary-cardiac-t-cell-lymphoma-in-a-stk4-deficient-patient-a-case-report
#9
Roya Sherkat, Mohammad Reza Sabri, Bahar Dehghan, Hamid Bigdelian, Nahid Reisi, Nooshin Afsharmoghadam, Hamid Rahimi, Narges Rahmanian, Cristoph Klein
RATIONALE: Primary cardiac lymphoma (PLC) is an extremely uncommon malignancy. PCL is more common in secondary immunodeficient patients. In this report, we describe a unique case of PLC who had been diagnosed as a STK4 deficient patient. This case is the first Primary immunodeficiency (PID) patient developing PCL in the world. PATIENT CONCERNS: An eleven-year-old girl, a known case of PID, was referred to the pediatric cardiology department because of chest pain and dyspnea...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29307034/emergency-department-imaging-of-pediatric-trauma-patients-during-combat-operations-in-iraq-and-afghanistan
#10
Jason F Naylor, Michael D April, Jamie L Roper, Guyon J Hill, Paul Clark, Steven G Schauer
BACKGROUND: Military hospitals in Iraq and Afghanistan treated children with traumatic injuries during the recent conflicts. Diagnostic imaging is an integral component of trauma management; however, few published data exist on its use in the wartime pediatric population. OBJECTIVE: The authors describe the emergency department (ED) utilization of radiology resources for pediatric trauma patients in Iraq and Afghanistan. MATERIALS AND METHODS: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric patients admitted to military fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016...
January 6, 2018: Pediatric Radiology
https://www.readbyqxmd.com/read/29305076/system-level-process-change-improves-communication-and-follow-up-for-emergency-department-patients-with-incidental-radiology-findings
#11
Steven J Baccei, Sneha A Chinai, Martin Reznek, Scott Henderson, Kevin Reynolds, D Eric Brush
The appropriate communication and management of incidental findings on emergency department (ED) radiology studies is an important component of patient safety. Guidelines have been issued by the ACR and other medical associations that best define incidental findings across various modalities and imaging studies. However, there are few examples of health care facilities designing ways to manage incidental findings. Our institution aimed to improve communication and follow-up of incidental radiology findings in ED patients through the collaborative development and implementation of system-level process changes including a standardized loop-closure method...
January 3, 2018: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29304160/a-retrospective-review-of-vital-signs-and-clinical-outcomes-of-febrile-infants-younger-than-3-months-old-presenting-to-the-emergency-department
#12
Shu-Ling Chong, Gene Yong-Kwang Ong, Wendy Yi Wen Chin, John Mingzhou Chua, Praseetha Nair, Alicia Shu Zhen Ong, Kee Chong Ng, Ian Maconochie
OBJECTIVES: Febrile infants younger than 3 months old present a diagnostic dilemma to the emergency physician. We aim to describe a large population of febrile infants less than 3 months old presenting to a pediatric emergency department (ED) and to assess the performance of current heart rate guidelines in the prediction of serious infections (SI). MATERIALS AND METHODS: We performed a retrospective review of febrile infants younger than 3 months old, between March 2015 and Feb 2016, in a large tertiary pediatric ED...
2018: PloS One
https://www.readbyqxmd.com/read/29303827/transitioning-to-a-new-facility-the-crucial-role-of-employee-engagement
#13
Meredith Slosberg, Adeleh Nejati, Jennie Evans, Upali Nanda
Transitioning to a new facility can be challenging for employees and detrimental to operations. A key aspect of the transition is employee understanding of, and involvement in, the design of the new facility. The literature lacks a comprehensive study of the impact of change engagement throughout the design, construction, and activation of a project as well as how that can affect perceptions, expectations, and, eventually, satisfaction of employees. The purpose of this research was to examine employee perceptions and satisfaction throughout a hospital design, construction, and activation process...
January 2018: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/29303766/no-additional-value-of-conventional-and-high-sensitivity-cardiac-troponin-over-clinical-scoring-systems-in-the-differential-diagnosis-of-type-1-versus-type-2-myocardial-infarction
#14
Luciano Consuegra-Sánchez, Juan José Martínez-Díaz, Luis García de Guadiana-Romualdo, Samantha Wasniewski, Patricia Esteban-Torrella, Francisco Guillermo Clavel-Ruipérez, Alfredo Bardají, Juan Antonio Castillo-Moreno, Juan Carlos Kaski
BACKGROUND: The distinction of type 1 and type 2 myocardial infarction (MI) is of major clinical importance. Our aim was to evaluate the diagnostic ability of absolute and relative conventional cardiac troponin I (cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) in the distinction between type 1 and type 2 MI in patients presenting at the emergency department with non-ST-segment elevation acute chest pain within the first 12 h. METHODS: We measured cTnI (Dimension Vista) and hs-cTnT (Cobas e601) concentrations at presentation and after 4 h in 200 patients presenting with suspected acute MI...
January 5, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/29302195/can-base-excess-and-anion-gap-predict-lactate-level-in-diagnosis-of-septic-shock
#15
Werapon Pongmanee, Veerapong Vattanavanit
Background: Lactate measurement is the key component in septic shock identification and resuscitation. However, point-of-care lactate testing is not widely used due to the lack of access to nearby test equipment. Biomarkers such as serum lactate, anion gap (AG), and base excess (BE) are used in determining shock in patients with seemingly normal vital signs. Purpose: We aimed to determine if these biomarkers can be used interchangeably in patients with septic shock in the emergency setting...
2018: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/29301176/sudden-paraplegia-caused-by-nontraumatic-cervical-disc-rupture-a-case-report
#16
Sung Min Kim, Byeong Sam Choi, Sungjoon Lee
A 38-year-old man visited our Emergency Department for sudden onset paraplegia that occurred 1 hour ago. He felt a piercing pain in the posterior neck and became paraplegic while he was watching television, lying down on a sofa. Neurological examination showed motor power grades II-III in both arms and grade 0 in both legs. His cervical magnetic resonance imaging (MRI) showed a large ruptured disc at the C5-6 level, severely compressing the spinal cord. Emergency anterior cervical discectomy and fusion at C5-6 were performed...
December 2017: Korean Journal of Spine
https://www.readbyqxmd.com/read/29299864/the-effect-of-temperature-on-airborne-filamentous-fungi-in-the-indoor-and-outdoor-space-of-a-hospital
#17
Fariba Abbasi, Mohammad Reza Samaei
Fungi are one of the bioaerosols in indoor air of hospitals. They have adverse effects on staff and patients. The aim of this study was to investigate the effects of three incubation temperature on the density and composition of airborne fungi in an indoor and outdoor space of hospital. Sabouraud dextrose agar was used for culture the fungi. For improvement of aseptic properties, chloramphenicol was added to this medium. The density of airborne fungi was less than 282 CFU/m3. The highest density was detected in emergency room and the lowest of them was in neonatal intensive care unit (NICU) and operation room (OR)...
January 3, 2018: Environmental Science and Pollution Research International
https://www.readbyqxmd.com/read/29298710/emergency-medicine-for-25%C3%A2-years-in-iceland-history-of-the-specialty-in-a-nutshell
#18
Jón Baldursson, Hjalti Már Björnsson, Ari Palomäki
After the early implementation of Emergency Medicine (EM) 25 years ago, Iceland became the first Nordic country to nationally realize the benefits of this specialty. However, the road has been rocky as in many other countries. The early years of EM in Iceland were characterized by a significant shortage of resources, particularly a lack of medical staff dedicated to EM and properly trained for the services required. The main task for the first couple of decades was to build the infrastructure of an operational emergency department based primarily on the model of EM...
January 3, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29295971/special-k-with-no-license-to-kill-accidental-ketamine-overdose-on-induction-of-general-anesthesia
#19
Lindsay L Warner, Nathan Smischney
BACKGROUND Ketamine is used as an induction and sedation agent in emergency departments and operating rooms throughout the country. Despite its widespread clinical use, there are few cases of significant morbidity and mortality attributed to ketamine overdose in the clinical setting. CASE REPORT The anesthesia provider in the room was an oral maxillofacial surgeon who inadvertently took out a more highly concentrated bottle of ketamine that is typically used for pediatric patients. The patient received 950 mg (100 mg/ml concentration) of intravenous ketamine instead of the intended 95 mg (10 mg/ml concentration)...
January 3, 2018: American Journal of Case Reports
https://www.readbyqxmd.com/read/29290506/thigh-emphysema-as-the-initial-presentation-of-colon-ischemia
#20
Chin-Chuan Hsu, Ping-Yuan Chen, Chih-Cheng Lai
The incidence of colon ischemia has increased in recent years, and is associated with high morbidity and mortality. The typical presentations of colon ischemia include abdominal pain, bloody diarrhea, and in severe case, ileus, fever and peritonitis. Here, we document a rare case of colon ischemia presenting with subcutaneous and intramuscular emphysema of the thigh. A 76-year-old woman presented to the emergency department for left thigh pain for three days. Physical examination revealed tenderness without obvious crepitus, erythema or swelling over the left groin area and a soft abdomen without tenderness...
December 6, 2017: American Journal of Emergency Medicine
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