The American journal of emergency medicine
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ST-elevation myocardial infarction (STEMI) identification by emergency medicine services (EMS) leading to pre-hospital catheterization laboratory (CL) activation shortens ischemic time and improves outcomes. We examined the incremental value of addition of a screening clinical tool (CT), containing clinical information and a Zoll electrocardiogram (ECG)-resident STEMI identification program (ZI) to ZI alone. ⋯ In an urban cohort of all EMS transmitted ECGs, ZI has high sensitivity and specificity for STEMI identification. Whereas the PPV was low, reflecting both low STEMI prevalence and presence of STEMI-mimics, the NPV was very high. These findings suggest that a simplified CT combined with computer STEMI interpretation can identify patients for pre-hospital CL activation. Confirmation of these results could improve the design of STEMI care systems.
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Case Reports
LUCAS 2™ device, compression depth, and the 2010 cardiopulmonary resuscitation guidelines.
The 2010 guidelines for cardiopulmonary resuscitation recommends that the chest be compressed at least 5 cm, with evidence that depths exceeding 5 cm may further aid resuscitation. The current piston-based mechanical device LUCAS 2™ is programmed to deliver a compression depth of 5 cm. ⋯ These cases depict limitations of the LUCAS 2™ device and the importance of guiding chest compression by physiological parameters. Consideration should be given to modifications to the LUCAS 2™, allowing rescuers to increase depth when required to optimize the hemodynamic efficacy of chest compression.
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Operational data are often used to make systems changes in real time. Inaccurate data, however, transiently, can result in inappropriate operational decision making. Implementing electronic health records (EHRs) is fraught with the possibility of data errors, but the frequency and magnitude of transient errors during this fast-evolving systems upheaval are unknown. This study was done to assess operational data quality in an emergency department (ED) immediately before and after an EHR implementation. ⋯ This single-center study raises questions about operational data quality in the peri-implementation period of EHRs. Using electronic timestamps for operational assessment and decision making following implementation should recognize the magnitude and compounding of errors when computing service times.
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Vibrio vulnificus causes potentially life-threatening and rapidly progressing infections. Therefore, the severity-of-illness assessment appears to be important for V vulnificus-infected patients at the time of admission. The aim of our study was to evaluate the performance of the severity-of-illness scoring model on admission in V vulnificus-infected patients. ⋯ The REMS could provide clinicians with an effective adjunct risk stratification tool for V vulnificus-infected patients.
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Aortic dissections can be challenging to diagnose in the emergency department (ED) because patients can present with a variety of complaints. We present a case involving a woman with multiple comorbidities, who had experienced intermittent abdominal pain for several months, which worsened in the days leading up to her ED visit. ⋯ Her dissection and pancreatitis were managed medically with tight blood pressure control without the need for surgical intervention. Several case studies associating acute aortic dissection with acute pancreatitis have been published, but it remains unclear whether these 2 conditions have a causal relationship.