The American journal of emergency medicine
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Exacerbation of chronic obstructive pulmonary disease (COPD) is a disease pattern frequently seen in emergency medical services and intensive care units. Usually, exacerbations of COPD are of infectious origin, and an acute vital threat may take several days to develop. Tension pneumothorax in patients with COPD is a rare and often unexpected cause of acute vital threat. ⋯ Pneumothorax was diagnosed in the hospital by chest x-ray and resolved after pleural drainage. The patient could be extubated early and discharged without sequelae. In conclusion, we want to report the occurrence of a tension pneumothorax as an important and potentially overseen condition in patients with COPD with acute respiratory failure.
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Differences in disposition between emergency physicians (EPs) have been studied in select patient populations but not in general emergency department (ED) patients. After determining whether a difference existed in admit/discharge decision making of EPs for general ED patients, we focus our study in examining the influence of EP seniority on the decision to discharge ED patients. ⋯ EPs vary in their admit/discharge decision making for general ED patients. More importantly, the most senior EPs were found to have the lowest discharge rates compared with their junior colleagues.
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In recent years, significant growth has been seen in the field of emergency medicine. However, the national productivity to the field of emergency medicine remains unknown. This study aimed to reveal the national contributions in the field of emergency medicine. ⋯ United States is the most productive country in the field of emergency medicine.
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Emergency department (ED) staff comments frequently about how patients are poorly prepared to answer important medical questions. To determine if the impression that patients were or were not prepared, a total of 309 patients were all asked a series of important medical questions and were graded as positive (or prepared) if they answered the question completely or negative (unprepared) if they partially answered, did not answer, or changed their answer during the ED stay. The patient population was older (mean age, 60 years) and was seen at 1 specialty hospital. ⋯ Patients were least prepared to know about an advance directive (79%) or to know their complete medical history (70%). Results indicated that most patients (99%) were not prepared to answer at least 1 or more important medical questions. The discussion considers why patients and others are not prepared for an ED visit and provides examples of ways to help people better prepare for such a visit.
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Mild induced hypothermia (MIH) is recommended to treat neurologic injury after cardiac arrest (CA). However, clinical trials to assess MIH benefit after CA have been largely inconclusive. We investigated the subsequent changes in cerebrospinal fluid (CSF) biochemistry after MIH (33°C-34°C for 12 hours) and evaluated the importance of ongoing fever control. ⋯ Mild induced hypothermia mitigated and delayed the CA-induced increase of CSF glutamate. Therefore, our results suggest that clinically inducing hypothermia as soon as possible after CA, or prolonging the time of MIH in combination with controlling ongoing fever, may enhance hypothermic protective effects.