Annals of emergency medicine
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Emergency department (ED) crowding represents an international crisis that may affect the quality and access of health care. We conducted a comprehensive PubMed search to identify articles that (1) studied causes, effects, or solutions of ED crowding; (2) described data collection and analysis methodology; (3) occurred in a general ED setting; and (4) focused on everyday crowding. Two independent reviewers identified the relevant articles by consensus. ⋯ The results illustrated the complex, multifaceted characteristics of the ED crowding problem. Additional high-quality studies may provide valuable contributions toward better understanding and alleviating the daily crisis. This structured overview of the literature may help to identify future directions for the crowding research agenda.
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The purpose of this study is to determine fetal outcomes of women diagnosed with live intrauterine pregnancy after emergency department (ED) presentation for abdominopelvic pain or vaginal bleeding during the first trimester. ⋯ Fetal loss before 20 weeks occurs in 9.2% of patients with live intrauterine pregnancy diagnosed by ultrasonography. Vaginal bleeding carries a higher fetal loss rate of 13.8%. These data will assist the emergency physician in counseling women experiencing symptomatic first trimester pregnancy.
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We conduct a prospective independent validation of the San Francisco Syncope Rule to identify emergency department (ED) syncope patients with short-term serious outcomes. ⋯ In this independent validation study, sensitivity and negative likelihood ratio of the San Francisco Syncope Rule were substantially lower than reported in the original studies and suggest that the rule has limited generalizability.
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A 54-year-old man with an inferior vena cava filter in situ presented to the emergency department (ED) by emergency medical services, with acute onset of severe abdominal, lower back, and leg pain. He had fallen from a ladder 3 days before admission. An abdominal computed tomography scan revealed a large retroperitoneal hematoma and evidence of occlusive thrombus in the inferior vena cava, extending beyond the inferior vena cava filter. ⋯ The patient underwent bilateral fasciotomies of the lower extremities within 3 hours. Postoperatively, he developed extensive tissue necrosis and gangrene, requiring bilateral above-the-knee amputations, and acute renal failure associated with severe rhabdomyolysis, requiring hemodialysis. This case highlights the importance of prompt recognition and treatment of inferior vena cava filter thrombosis.
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To develop a discrete event simulation of emergency department (ED) patient flow for the purpose of forecasting near-future operating conditions and to validate the forecasts with several measures of ED crowding. ⋯ By modeling patient flow, rather than operational summary variables, our simulation forecasts several measures of near-future ED crowding, with various degrees of good performance.