Annals of emergency medicine
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Chest pain units have been used to monitor and investigate emergency department (ED) patients with potential ischemic chest pain to reduce the possibility of missed acute coronary syndrome. We seek to optimize the use of hospital resources by implementing a chest pain diagnostic algorithm. ⋯ In ED patients with chest pain, a structured diagnostic approach with time-focused ED decision points, brief observation, and selective application of early outpatient provocative testing appears both safe and diagnostically efficient, even though some patients with acute coronary syndrome may be discharged for outpatient stress testing on the index ED visit.
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Cardiac dysrhythmias are a common problem in the United States. Radiofrequency ablation is being used more frequently as a treatment for these diagnoses. Although rare, serious complications such as cardiac tamponade have been reported as a result of ablation procedures. ⋯ Although this was associated with large blood loss, we believed that using the traditional method of completely removing the pericardium would have resulted in uncontrolled hemorrhage. Instead, our method led to successful resuscitation of the patient until definitive care was available. A smaller pericardial incision than is traditionally used during ED thoracotomy deserves further consideration and research to determine whether and when it may be most useful as a temporizing treatment of cardiac tamponade when other methods have failed.
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The quality measure "Rh immunoglobulin administration for Rh-negative women at risk for fetal blood exposure" was recently endorsed by the National Quality Forum. No published data have shown a related performance gap in US emergency departments (EDs). We determine performance in a US ED for appropriate Rh testing and treatment among pregnant ED patients at risk of fetal blood exposure. ⋯ In this single-center study, among patients with a sensitizing event, performance was moderate for Rh testing and treatment with Rh immunoglobulin. Despite lack of consensus or uncertainties in certain measure definitions, in at least 1 US academic ED there appears to be an opportunity for further evaluation and performance improvement in this area.