Journal of the American College of Emergency Physicians open
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J Am Coll Emerg Physicians Open · Aug 2020
Canadian emergency physician psychological distress and burnout during the first 10 weeks of COVID-19: A mixed-methods study.
The aim of this study was to report burnout time trends and describe the psychological effects of working as a Canadian emergency physician during the first weeks of the coronavirus disease 2019 (COVID-19) pandemic. ⋯ Emergency physician burnout levels remained stable during the initial 10 weeks of this pandemic. The impact of COVID-19 on the work environment and personal perceptions and fears about the impact on lifestyle have affected physician well-being.
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J Am Coll Emerg Physicians Open · Aug 2020
The safety of home discharge for low-risk emergency department patients presenting with coronavirus-like symptoms during the COVID-19 pandemic: A retrospective cohort study.
There is minimal evidence describing outcomes for emergency department (ED) patients with suspected coronavirus disease 2019 (COVID-19) infection who are not hospitalized. The study objective was to assess 30-day outcomes (ED revisit, admission, ICU admission, and death) for low-risk patients discharged after ED evaluation for COVID-19. ⋯ A minority of low-risk patients with suspected COVID-19 will require hospitalization after being discharged home from the ED. Outpatient management is likely safe for well-appearing patients with normal vital signs, but patients should be instructed to return for worsening symptoms including labored breathing. Future work is warranted to develop and validate ED disposition guidelines.
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J Am Coll Emerg Physicians Open · Aug 2020
First-attempt intubation success and complications in patients with COVID-19 undergoing emergency intubation.
To evaluate the first-attempt success rates and complications of endotracheal intubation of coronavirus disease 2019 (COVID-19) patients by emergency physicians. ⋯ Emergency physicians achieve high success rates when intubating COVID19 patients, although complications are frequent. However, these findings should be considered provisional until their generalizability is assessed in their institutions and setting.
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J Am Coll Emerg Physicians Open · Aug 2020
Point-of-care hip ultrasound leads to expedited results in emergency department patients with suspected septic arthritis.
The evaluation of septic hip arthritis often incorporates the utilization of hip ultrasonography to determine the presence of a hip joint effusion, as well as to guide arthrocentesis. Point-of-care (POC) hip ultrasound has previously been demonstrated to be accurate when performed by the emergency physician. Time to diagnosis and subsequent intervention in septic arthritis (SA) is critical to favorable outcomes. ⋯ There was a statistically shorter time to ultrasound result and arthrocentesis when POC hip ultrasound was utilized by the emergency physician. Given that unfavorable outcomes in SA are associated with delay in treatment, further study is warranted to determine if emergency physician-performed hip ultrasound and arthrocentesis could lead to improved patient-centered clinical end points.
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J Am Coll Emerg Physicians Open · Aug 2020
Extracorporeal cardiopulmonary resuscitation for in- and out-of-hospital cardiac arrest: systematic review and meta-analysis of propensity score-matched cohort studies.
In this systematic review and meta-analysis of propensity score-matched cohort studies, we quantitatively summarize whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) used as extracorporeal cardiopulmonary resuscitation (ECPR), compared with conventional cardiopulmonary resuscitation (CCPR), is associated with improved rates of 30-day and long-term favorable neurological outcomes and survival in patients resuscitated from in- and out-of-hospital cardiac arrest. ⋯ Our analysis suggests that VA-ECMO used as ECPR may improve long-term favorable neurological outcomes and survival when compared to the best standard of care in a selected patient population. Therefore, it is imperative for well-designed randomized clinical trials to obtain a higher level of scientific evidence to ensure optimal outcomes for cardiac arrest patients.