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https://www.readbyqxmd.com/read/29457737/determining-the-value-of-cerebrospinal-fluid-lactate-dehydrogenase-level-in-differentiating-subarachnoid-hemorrhage-from-traumatic-lumbar-puncture
#1
Morteza Saeedi, Elnaz Vahidi, Shirin Asri, Amirhosein Jahanshir
CONTEXT: - Lumbar puncture (LP) is still an important modality in the diagnosis of subarachnoid hemorrhage (SAH). Rapid and correct fluid analysis can provide patients with a better prognosis by appropriate intervention. OBJECTIVE: - To determine the value of cerebrospinal fluid lactate dehydrogenase level in differentiation between SAH and traumatic LP. DESIGN: - This was a cross-sectional observational study. Patients with a diagnostic suspicion of SAH, who were admitted to the emergency department, were enrolled in our study based on the inclusion criteria...
February 19, 2018: Archives of Pathology & Laboratory Medicine
https://www.readbyqxmd.com/read/29457258/quality-of-prescribing-by-physicians-nurse-practitioners-and-physician-assistants-in-the-united-states
#2
Shiyin Jiao, Irene B Murimi, Randall S Stafford, Ramin Mojtabai, G Caleb Alexander
OBJECTIVE: Nurse practitioners (NPs) and physician assistants (PAs) have increasingly broad prescribing authority in the United States, yet little is known regarding how the quality of their prescribing practices compares to that of physicians. The objective of this study was to compare the quality of prescribing practices of physicians and non-physician providers. METHODS: A serial cross-sectional analysis of the 2006-2012 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) was performed...
February 19, 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29457209/agreement-between-integrated-management-of-childhood-illness-and-final-diagnosis-in-acute-respiratory-tract-infections
#3
Sıddika Songül Yalçın, Beril Özdemir, Sadriye Özdemir, Esra Baskın
OBJECTIVE: To evaluate the agreement between integrated management of childhood illness (IMCI) and final diagnosis in patients presenting with cough at the second and third level health institutions. METHODS: This cross-sectional study included 373 children aged 2-60 mo who presented with cough at the pediatric emergency and outpatient clinics in the Department of Pediatrics. After clinical examination of children, body temperature, respiratory rate, saturation, presence or absence of the chest indrawing, rales, wheezing and laryngeal stridor were recorded...
February 19, 2018: Indian Journal of Pediatrics
https://www.readbyqxmd.com/read/29456990/ketamine-versus-ketamine-magnesium-sulfate-for-procedural-sedation-and-analgesia-in-the-emergency-department-a-randomized-clinical-trial
#4
Reza Azizkhani, Azadeh Bahadori, Mohammadreza Shariati, Keyhan Golshani, Omid Ahmadi, Babak Masoumi
Background: The present study was designed to evaluate the effectiveness of magnesium sulfate (MgSO4 ) in procedural sedation and analgesia (PSA) when combined with ketamine in patients with fractures in emergency departments and required short and painful emergency procedures. Materials and Methods: In this study, 100 patients with fractures and dislocations who were presented to the emergency departments and required PSA for short and painful emergency procedures were randomly allocated to groups of ketamine plus MgSO4 or ketamine alone...
2018: Advanced Biomedical Research
https://www.readbyqxmd.com/read/29456607/temporising-an-extradural-haematoma-by-intraosseous-needle-craniostomy-in-the-district-general-hospital-by-non-neurosurgical-doctors-a-case-report
#5
Sahra Durnford, Harry Bulstrode, Andrew Durnford, Aabir Chakraborty, Nicholas T Tarmey
We report the case of a 69-year-old man admitted to the emergency department of a UK district general hospital with an extradural haematoma following closed head injury. He deteriorated rapidly before transfer to the regional neurosurgical centre and was treated with decompression of the extradural haematoma through an EZ-IO™ intraosseous needle in our department, with telephone guidance from the neurosurgeon. We believe this to be the first reported use of this technique in a district general hospital.
February 2018: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29456604/death-from-kratom-toxicity-and-the-possible-role-of-intralipid
#6
Geeta Aggarwal, Edward Robertson, James McKinlay, Edward Walter
We present the case of a 26-year-old man who was brought into our emergency department in cardiorespiratory arrest, having taken Kratom 24 h previously. Despite multi-organ support, he deteriorated and died from cardiorespiratory failure and hypoxic brain damage 12 h later. Lipid emulsion was given, with significant temporary improvement in the cardiorespiratory failure. Kratom is derived from Mitragyna speciosa, a tropical deciduous and evergreen tree in the coffee family, and is native to Southeast Asia, and its leaves are used as a legal high in some parts of the world...
February 2018: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29456595/geographical-access-to-critical-care-services-in-scotland
#7
Philip Emerson, Naomi Dodds, David R Green, Jan O Jansen
Background: Critical illness requires specialist and timely management. The aim of this study was to create a geographic accessibility profile of the Scottish population to emergency departments and intensive care units. Methods: This was a descriptive, geographical analysis of population access to 'intermediate' and 'definitive' critical care services in Scotland. Access was defined by the number of people able to reach services within 45 to 60 min, by road and by helicopter...
February 2018: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29456175/metformin-induced-lactic-acidosis-mila-a-case-report-and-review-of-current-diagnostic-paradigm
#8
Lauren Krowl, Hassan Al-Khalisy, Pratibha Kaul
A new diagnostic paradigm has been proposed to better categorize causes of Metformin-Associated Lactic Acidosis (MALA). The diagnostic criteria defines a link between Metformin and lactic acidosis if lactate is >5mmol/L, Ph<7.35 and Metformin assay >5mg/L. Metformin assays are not readily available in emergency departments including nationwide Veteran's Affairs Hospitals; thereby making this proposed classification tool difficult to use in today's clinical practice. We describe a case report of a 45-year-old male, who took twice the amount of Metformin prescribed and presented with Metformin-induced lactic acidosis...
February 15, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29456174/bilateral-maculopathy-after-exposure-to-a-laser-pointer-optical-coherence-tomography-angiography-findings
#9
R Clemente-Tomás, P Bayo-Calduch, P Neira-Ibáñez, A Gargallo-Benedicto, A M Duch-Samper
CASE REPORT: A 36-year-old man went to the emergency department the day after exposure to a laser pointer. Funduscopy revealed dispersed macular pigment alterations, and optical coherence tomography showed a disruption of the retinal layers. The visual acuity was counting fingers in both eyes. Nine months later, optical coherence tomography angiography showed a rarefaction in the choriocapillaris vascular flow in the area of the laser injuries. DISCUSSION: The retinal layer mainly damaged by the laser injury was the retinal pigment epithelium...
February 15, 2018: Archivos de la Sociedad Española de Oftalmología
https://www.readbyqxmd.com/read/29456086/low-dose-propofol-for-pediatric-migraine-a-prospective-randomized-controlled-trial
#10
David C Sheridan, Matthew L Hansen, Amber L Lin, Rongwei Fu, Garth D Meckler
BACKGROUND: Migraine headaches are a common reason for pediatric emergency department (ED) visits. Small studies suggest the potential efficacy of sub-anesthetic doses of propofol for migraine with a favorable side effect profile and potentially decreased length of stay (LOS). OBJECTIVE: The objective of this study was to compare the efficacy of low-dose propofol (LDP) to standard therapy (ST) in pediatric migraine treatment. METHODS: We conducted a prospective, pragmatic randomized controlled trial from April 2014 through June 2016 in the ED at two pediatric hospitals...
February 15, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29456085/what-is-the-role-of-reversal-agents-in-the-management-of-emergency-department-patients-with-dabigatran-associated-hemorrhage
#11
Bryan D Hayes, Michael E Winters, Steve B Rosenbaum, Mohannad F Allehyani, Gary M Vilke
BACKGROUND: In 2010, the U.S. Food and Drug Administration (FDA) approved dabigatran as the first non-warfarin oral anticoagulant for use in the United States. At the time of FDA approval, there was no antidote or effective treatment for dabigatran-induced hemorrhage. In 2015, the FDA approved idarucizumab for the treatment of dabigatran-induced hemorrhage. The purpose of this clinical practice statement is to evaluate the role of select reversal agents in the management of patients with dabigatran-associated bleeding...
February 15, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29455680/emergency-medical-service-ems-utilization-by-syrian-refugees-residing-in-ankara-turkey
#12
Ali Osman Altıner, Sıdıka Tekeli Yeşil
Introduction Many Syrians have left their country and migrated to other countries since March 2011, due to the civil war. As of March 2016, a total of 2,747,946 Syrian refugees had immigrated to Turkey. Some Syrian refugees have been living in camps, while 2,475,134 have been living in metropolitan areas, such as Ankara. Study Objective This study investigated Emergency Medical Service (EMS) utilization among Syrian refugees residing in Ankara. METHODS: This study was a descriptive, cross-sectional database analysis using data obtained from the Department of EMS of the Ankara Provincial Health Directorate...
February 19, 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29455453/homelessness-and-emergency-medicine-where-do-we-go-from-here
#13
Kelly M Doran, Maria C Raven
In many emergency departments (EDs) around the country, providers care for patients experiencing homelessness on every single shift. Despite its proven impact on health, housing status is not a routine part of the history taken by most emergency providers, and in many cases providers are unaware that they are caring for someone who has no stable home. Patients experiencing homelessness have unique needs spanning acute and chronic illness, injury, behavioral health diagnoses, and material deprivation. This article is protected by copyright...
February 17, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29455441/a-proactive-transfer-policy-for-critical-patient-flow-management
#14
Jaime González, Juan-Carlos Ferrer, Alejandro Cataldo, Luis Rojas
Hospital emergency departments are often overcrowded, resulting in long wait times and a public perception of poor attention. Delays in transferring patients needing further treatment increases emergency department congestion, has negative impacts on their health and may increase their mortality rates. A model built around a Markov decision process is proposed to improve the efficiency of patient flows between the emergency department and other hospital units. With each day divided into time periods, the formulation estimates bed demand for the next period as the basis for determining a proactive rather than reactive transfer decision policy...
February 17, 2018: Health Care Management Science
https://www.readbyqxmd.com/read/29455390/utility-of-multiple-rule-out-ct-screening-of-high-risk-atraumatic-patients-in-an-emergency-department-a-feasibility-study
#15
Mia M Pries-Heje, Rasmus B Hasselbalch, Henriette Raaschou, Bijan Rezanavaz-Gheshlagh, Hanne Heebøll, Shazia Rehman, Mariana Kristensen, Erik Henning Andersen, Lisbet Ravn, Michel C Nèmery, Morten N Lind, Thomas Boel, Peter Sommer Ulriksen, Kasper K Iversen
BACKGROUND: Several large trials have evaluated the effect of CT screening based on specific symptoms, with varying outcomes. Screening of patients with CT based on their prognosis alone has not been examined before. For moderate-to-high risk patients presenting in the emergency department (ED), the potential gain from a CT scan might outweigh the risk of radiation exposure. We hypothesized that an accelerated "multiple rule out" CT screening of moderate-to-high risk patients will detect many clinically unrecognized diagnoses that affect change in treatment...
February 17, 2018: Emergency Radiology
https://www.readbyqxmd.com/read/29455120/amyand-s-hernia-with-acute-gangrenous-appendicitis-and-cecal-perforation-a-case-report-and-review-of-the-literature
#16
William Kromka, Aline S Rau, Charles J Fox
INTRODUCTION: An Amyand's hernia is a heterogeneous clinical condition defined by the presence of the vermiform appendix within an inguinal hernia sac, which may or may not contain other abdominal contents or pathologic inflammatory changes. Herein we present an exceptionally rare case of an Amyand's hernia containing acute appendicitis and a perforated cecum. PRESENTATION OF CASE: A 46-year-old male with a right inguinal hernia of 2-3 year duration presented to our Emergency Department complaining of acute onset abdominal and groin pain...
February 14, 2018: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29455017/thrombectomy-devices-in-the-treatment-of-acute-mesenteric-ischemia-initial-single-center-experience
#17
Bruno Freitas, Yvonne Bausback, Johannes Schuster, Matthias Ulrich, Sven Bräunlich, Andrej Schmidt, Dierk Scheinert
INTRODUCTION: To report our preliminary experience with endovascular revascularization of patients with acute mesenteric ischemia (AMI), using thrombectomy devices. MATERIAL AND METHODS: A retrospective analysis of patients admitted to our hospital due to AMI and who were subjected to concomitant or exclusive endovascular treatment, from January 2011 to January 2016. Patients were admitted at the emergency department, underwent imaging investigation and were referred to the endovascular specialist...
February 15, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29454810/predictors-of-functional-outcome-after-hanging-injury
#18
Chia-Lung Kao, I-Lin Hsu
PURPOSE: Suicide becomes a serious problem in today's society and hanging is a common method of suicide. We want to find the factors which can predict the final functional outcomes of these cases. METHODS: All patients who presented to Accident and Emergency Department (ED) of the National Cheng Kung University Hospital from 1st January 2005 to 31th December 2013 with a hanging injury were included in this study. All cases were divided into good outcome group and bad outcome group according to Glasgow Outcome Scale (GOS)...
January 31, 2018: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29454739/spanish-and-catalan-translation-cultural-adaptation-and-validation-of-the-picker-patient-experience-questionnaire-15
#19
M J Bertran, M Viñarás, M Salamero, F Garcia, C Graham, A McCulloch, J Escarrabill
OBJECTIVE: To develop and test a culturally adapted core set of questions to measure patients' experience after in-patient care. MATERIAL AND METHODS: Following the methodology recommended by international guides, a basic set of patient experience questions, selected from Picker Institute Europe questionnaires (originally in English), was translated to Spanish and Catalan. Acceptability, construct validity and reliability of the adapted questionnaire were assessed via a cross-sectional validation study...
February 14, 2018: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
https://www.readbyqxmd.com/read/29454714/interphysician-differences-in-emergency-department-length-of-stay
#20
Stephen J Traub, Soroush Saghafian, Kurtis Judson, Christopher Russi, Bo Madsen, Stephen Cha, Hannah C Tolson, Leon D Sanchez, Jesse M Pines
BACKGROUND: Emergency physicians differ in many ways with respect to practice. One area in which interphysician practice differences are not well characterized is emergency department (ED) length of stay (LOS). OBJECTIVE: To describe how ED LOS differs among physicians. METHODS: We performed a 3-year, five-ED retrospective study of non-fast-track visits evaluated primarily by physicians. We report each provider's observed LOS, as well as each provider's ratio of observed LOS/expected LOS (LOSO/E ); we determined expected LOS based on site average adjusted for the patient characteristics of age, gender, acuity, and disposition status, as well as the time characteristics of shift, day of week, season, and calendar year...
February 14, 2018: Journal of Emergency Medicine
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