The American journal of emergency medicine
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Observational Study
Arterial lactate improves the prognostic performance of severity score systems in septic patients in the ED.
To evaluate the prognostic performance of lactate in septic patients in the emergency department (ED) and investigate how to add lactate to the traditional score systems. ⋯ Lactate is a prognostic predictor in septic patients in the ED, and it may improve the performance of APACHE II, SOFA, and MEDS scores in predicting mortality.
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The objective of this study was to determine if signs of clinical intoxication were present in patients who had transfer urine drug screens (UDS) performed and to determine the proportion of patients with UDS orders who were actually transferred to another facility. ⋯ Few (<6%) patients demonstrated any clinical characteristics that were consistent with an acute intoxication. Less than 20% of patients who had a transfer UDS were actually transferred to an outside facility corresponding with more than 80% not ordered appropriately according to the ED established guidelines. This number of inappropriate tests represented more than $152 000 of avoidable UDS cost during the study period.
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We aimed to determine if there are differences in bystander cardiopulmonary resuscitation (BCPR) provision and survival to hospital discharge from out-of-hospital cardiac arrest (OHCA) occurring in Hispanic neighborhoods in Arizona. ⋯ In Arizona, OHCA patients in Hispanic neighborhoods received BCPR less frequently and had a lower survival to hospital discharge rate than those in non-Hispanic white neighborhoods. Public health efforts to attenuate this disparity are needed.
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Syncope is a frequent presenting complaint in the emergency department and is associated with significant medical costs. We examined the utility of inpatient evaluation of syncope for patients in whom a diagnosis was not established in the emergency department. We retrospectively reviewed consecutive patients presenting with syncope to an urban tertiary care medical center. ⋯ Inhospital evaluation led to a diagnosis in 26 patients. Acute intervention was required in 2 patients. Our observations suggest that an inpatient evaluation of syncope for patients in whom a diagnosis is not made on initial evaluation is of low yield, and outpatient follow-up may be safe.