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Emergency department

Emil Brännström, Jennifer Strand, Peter Sand
Background: The aim of this qualitative study was to explore why some patients receive recurrent or prolonged psychiatric inpatient care, based on the experiences of the patients themselves. Methods: The participants were recruited at an outpatient clinic at the department of psychiatry for patients with affective disorders at Sahlgrenska University Hospital, Sweden. Ten patients, nine women and one man, aged 22-61 years, agreed to participate. A semi-structured interview guide was used during the interviews, which were audiotaped, transcribed, and analyzed using interpretative phenomenological analysis...
2018: International Journal of Mental Health Systems
Samuel H Kim, Nimesh Patel, Kanika Thapar, Ananda V Pandurangadu, Amit Bahl
Objectives: Greater saphenous vein (GSV) thrombosis is concerning due to its close proximity to the deep femoral vein. This study sought to identify the risk of propagation to deep vein thrombosis (DVT) or pulmonary embolism (PE) among patients with isolated proximal GSV superficial thrombosis and describe provider practice patterns related to treatment. Materials and methods: This is an Institutional Review Board-approved retrospective multi-center study. Patients presented to one of three possible emergency departments in a large health system...
2018: Vascular Health and Risk Management
Lara DePadilla, Gabrielle F Miller, Sherry Everett Jones, Alexis B Peterson, Matthew J Breiding
Increased susceptibility to concussions and longer recovery times among high school athletes compared with older athletes (1) make concussions among youths playing a sport or being physically active an area of concern. Short-term and long-term sequelae of concussions can include cognitive, affective, and behavioral changes (1). Surveillance methods used to monitor concussions among youths likely underestimate the prevalence. Estimates assessed from emergency departments miss concussions treated outside hospitals, those generated using high school athletic trainer reports miss concussions sustained outside of school-based sports (2), and both sources miss medically untreated concussions...
June 22, 2018: MMWR. Morbidity and Mortality Weekly Report
J Mac McCullough, Nicole Fowle, Tammy Sylvester, Melissa Kretschmer, Aurimar Ayala, Saskia Popescu, Jolie Weiss, Bob England
OBJECTIVE: To generate estimates of the direct costs of mounting simultaneous emergency preparedness and response activities to respond to 3 major public health events. DESIGN: A cost analysis was performed from the perspective of the public health department using real-time activity diaries and retrospective time and activity self-reporting, wage and fringe benefit data, and financial records to track costs. SETTING: Maricopa County Department of Public Health (MCDPH) in Arizona...
June 20, 2018: Journal of Public Health Management and Practice: JPHMP
Brady S Moffett, Mindl M Weingarten, Lindsay R Schmees, Marianne Galati, Jennifer Erklauer, James J Riviello
OBJECTIVE: The purpose of this study is to describe the pharmacokinetics of phenytoin in pediatric patients receiving fosphenytoin. DESIGN: Retrospective, population pharmacokinetic analysis. SETTING: Emergency department or PICU of a large tertiary care children's hospital. PATIENTS: Patients less than 19 years old who received fosphenytoin in the PICU or emergency center for treatment of seizures from January 2011 to June 2017 were included...
June 20, 2018: Pediatric Critical Care Medicine
Mia Kanak, Amanda Stewart, Robert Vinci, Shanshan Liu, Megan Sandel
OBJECTIVES: To describe a trend in emergency department (ED) use by homeless children and young adults before and after a state housing policy change in 2012 and to quantify financial and time costs to the health care system. METHODS: We retrospectively reviewed de-identified electronic medical records of homeless children and young adults aged 0 to 21 years seeking shelter at an urban tertiary pediatric ED in Boston, Massachusetts, between September 1, 2011, and August 31, 2016...
June 21, 2018: American Journal of Public Health
G Jiménez-Guerra, I Casanovas Moreno-Torres, M Gutiérrez-Soto, F Vazquez-Alonso, A Sorlózano-Puerto, J M Navarro-Marí, J Gutiérrez-Fernández
OBJECTIVE: Candida could become the second most frequent cause of nosocomial urinary tract infection. Although Candida albicans is the most important species, others have arisen as emerging pathogens. The aim of this study was to analyze the presence of candiduria in inpatients. METHODS: We performed a retrospective study of Candida isolates from adult inpatient urocultures over five years, gathering and tabulating data on: the species; susceptibility to fluconazole, amphotericin B, and voriconazole (Vitek2, BioMerieux); presence of catheter; hospital department of origin; and patient age and sex...
June 20, 2018: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
Serena L Orr, Marielle A Kabbouche, Paul S Horn, Hope L O'Brien, Joanne Kacperski, Susan LeCates, Shannon White, Jessica Weberding, Mimi N Miller, Scott W Powers, Andrew D Hershey
OBJECTIVES: To characterize a population of pediatric patients visiting an infusion center for acute migraine and determine predictors of first-line treatment success in this population. BACKGROUND: Though migraine is common in the pediatric emergency department and specialized infusion centers, little is known about this patient population and whether or not clinical data can be used to predict treatment response. METHODS: This was an observational study involving a retrospective analysis of data from visits to the Cincinnati Children's Hospital infusion center for treatment of an acute migraine...
June 21, 2018: Headache
K M Yim, H F Ko, M Lc Yang, T Y Li, S Ip, J Tsui
With Hong Kong's ageing population, advancement of medical technologies and hospital congestion, it is not uncommon for emergency physicians to encounter complicated critically ill patients in daily practice. It becomes a fundamental role of emergency physicians to initiate timely diagnostic and therapeutic interventions to save a patient's life and improve their prognosis. It is the reason a critical care service has been developed in emergency departments worldwide over the last decade. This article shares how emergency department intensivists can contribute to this novel model of care with some illustrative cases...
June 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Siamak Moayedi, Michael Witting, Jon Mark Hirshon, Nicholas George, Alise Burke, Stephen Schenkel
INTRODUCTION: Safe and efficient intravenous access is paramount to the practice of emergency medicine. We compared the first-stick success rates and blood spillage of two peripheral intravenous catheters in a busy urban emergency department. METHODS: In this randomized controlled trial, we assigned emergency department patients requiring peripheral intravenous access to use of either a flash-tip catheter (SurFlash Plus, Terumo Medical Corporation, Somerset, New Jersey) or a widely used control catheter (Insyte Autoguard; Becton, Dickinson and Company, Franklin Lakes, New Jersey)...
July 2018: Journal of Vascular Access
A C Chapelle, J M Rakic
Vascular ocular pathologies are common and usually diagnosed in the emergency department by the ophtalmologist. However, it is very important for the physicians and the general practitioners to know these different diseases for improving the visual and vital prognosis. This paper describes the most important ocular and cerebrovascular pathologies.
May 2018: Revue Médicale de Liège
M'Peko Osawa F Mayele, X Bertrand
Subarachnoid hemorrhage is a neurovascular emergency affecting relatively young adults. A ruptured cerebral aneurysm is the main non-traumatic cause. Except for the non-specific symptom of headache, which frequently occurs in subarachnoid hemorrhage, the clinical presentation is atypical, making the diagnosis difficult with possible dramatic consequences. The diagnosis is based on the CT scan without contrast, which, when negative, will be followed by a lumbar puncture. The etiologic analysis is based on an urgent arteriography, revealing the characteristics of the aneurysm such as the anatomy of the intracerebral vessels, the identification of the bleeding site and the size and location of the aneurysm...
May 2018: Revue Médicale de Liège
S Robinet, Casteren L Van, A Delcour, P Lancellotti
Cardiac arrhythmias are a common cause of admission in the emergency department. Among these, atrio-ventricular conductive disorders and malignant ventricular arrhythmias are among the most severe, requiring prompt and appropriate management to ensure the best prognosis. Knowledge of the pathophysiology and etiology causing these arrhythmias is mandatory in order to understand its management, acute and chronic, and to facilitate the dialogue between emergency physicians and cardiologists.
May 2018: Revue Médicale de Liège
V D'orio, A Ancion, P Lancellotti
Acute heart failure is a common cause of admission in emergency department. Management requires rapid support when haemodynamic or respiratory parameters are altered. Identifying enabling factors and their specific treatment is an integral part of management. The most common clinical presentation is volume overload, whose treatment remains the combination of diuretics and vasodilators. In case of impaired perfusion, various inotropic supports may be considered, but also more and more circulatory assistance devices...
May 2018: Revue Médicale de Liège
J Jobé, A Ghuysen, V D'Orio
To cope with overcrowding, a consequence of their constant growth, emergency departments have implemented operational strategies based on triage systems. Despite its interest, nurse triage has been limited by several hindrances, and new strategies are emerging. Among those, advanced nurse triage, allowing a nurse to initiate the diagnostic process just after categorization of the patient, seems to be promising. A study on advanced nurse triage for patients presenting with chest pain has been conducted in the emergency department of the CHU of Liège...
May 2018: Revue Médicale de Liège
Kathryn Lawton, Karen Royals, Kristin V Carson-Chahhoud, Fiona Campbell, Brian J Smith
BACKGROUND: Specialist nursing roles to manage stable disease populations are being used to meet the needs of both patients and health services. With increasing cost pressures on health departments, alternative models such as nurse-led care are gaining momentum as a substitute for traditional doctor-led care. This review evaluates the safety, effectiveness, and health outcomes of nurses practising in autonomous roles while using advanced practice skills, within the context of bronchiectasis management in subacute, ambulatory, and/or community care...
June 20, 2018: Cochrane Database of Systematic Reviews
Venkata Sunil Bendi, Abhishek Matta, Diego Torres-Russotto, James Shou
Non-ketotic hyperglycaemia (NKH) is the most common metabolic cause of hemichorea-hemiballismus (HC-HB) and an often-reversible condition. A 68-year-old man presented to the emergency department with a severe hyperglycaemic episode and altered mental status. He was treated appropriately and discharged home after his blood glucose levels were normal with an improvement of mental status. Four weeks after the discharge, he returned with flailing movements of bilateral upper and lower limbs. MRI of the brain revealed hyperintensities of the bilateral putamen on T1-weighted imaging...
June 19, 2018: BMJ Case Reports
Ashuin Kammar-García, Ziv Pérez-Morales, Lilia Castillo-Martinez, José Luis Villanueva-Juárez, Fernanda Bernal-Ceballos, Héctor Isaac Rocha-González, Miguel Remolina-Schlig, Thierry Hernández-Gilsoul
PURPOSE OF THE STUDY: The aim of this study was to investigate the association of fluid overload, measured by bioelectrical impedance vector analysis (BIVA) and also by accumulated fluid balance, with 30-day mortality rates in patients admitted to the emergency department (ED). DESIGN: We conducted a prospective observational study of fluid overload using BIVA, taking measures using a multiple-frequency whole-body tetrapolar equipment. Accumulated fluid balances were obtained at 24, 48 and 72 hours from ED admission and its association with 30-day mortality...
June 20, 2018: Postgraduate Medical Journal
Lucas B Chartier, Samuel Vaillancourt, Amy H Y Cheng, Antonia S Stang
CLINICIAN'S CAPSULE What is known about the topic? The first two articles of this quality improvement (QI) Primer Series for emergency medicine (EM) clinicians reviewed foundational steps to prepare for and execute a QI project. What did this study ask? This article focused on the measurement, evaluation, and sustainability of QI projects. What did this study find? Run charts are used to represent the temporal relationship visually between interventions and the measures of interest. Sustainability of projects can be achieved through the use of specific frameworks, tools, and cultural change...
June 21, 2018: CJEM
Carson Gill, Brendan Arnold, Sean Nugent, Alykhan Rajwani, Michael Xu, Tyler Black, Quynh Doan
OBJECTIVES: The goal of this study was to assess the reliability of HEARTSMAP as a standardized tool for evaluating the quality of psychosocial assessment documentation of pediatric mental health presentations to the emergency department. In addition, we report on current documentation practices. METHODS: We conducted a retrospective cross-sectional study of pediatric (up to age 17) mental health-related visits to four emergency departments between April 1, 2013 and March 31, 2014...
June 20, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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