The American journal of emergency medicine
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Patients with implantable cardiac defibrillators not infrequently present to the emergency department after experiencing an implantable cardiac defibrillator shock. This review considers the management of such patients in the emergency department, including appropriate, inappropriate, and phantom shocks as well as electrical storm.
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Observational Study
A quick and easy delirium assessment for nonphysician research personnel.
Delirium in the emergency department (ED) is an emerging field of research. Most ED research infrastructures utilize lay personnel to collect data, but delirium assessments that can be reliably performed by nonphysicians are lacking. We evaluated the diagnostic performance of the modified Brief Confusion Assessment Method (modified bCAM) for this purpose. ⋯ The modified bCAM may be a feasible and accurate method for nonphysicians to assess for delirium. Future studies are needed to confirm these findings.
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Emergency physicians must be masters of the airway. The patient with tracheostomy can present with complications, and because of anatomy, airway and resuscitation measures can present several unique challenges. Understanding tracheostomy basics, features, and complications will assist in the emergency medicine management of these patients. ⋯ Tracheostomy patients can present unique challenges for emergency physicians. Knowledge of the basics and features of tracheostomy tubes can assist physicians in managing life-threatening complications including tube obstruction, decannulation, bleeding, stenosis, and fistula.
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Infectious Diseases Society of America guidelines recommend that patients hospitalized for acute bacterial skin infections after failure of outpatient antibiotic therapy be managed as "severe" infections; however, the clinical relevance of apparent failure of outpatient therapy is not clear. ⋯ Patients hospitalized with skin infections after apparently failing outpatient therapy had clinical features suggestive of less severe infection and similar outcomes compared with patients who did not receive antibiotics prior to admission. Our results suggest that inpatient treatment for patients not responding to outpatient therapy should focus on methicillin-resistant S aureus, not gram-negative pathogens.
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Observational Study
High-impact hepatitis C virus testing for injection drug users in an urban ED.
We implemented the "High-Impact Testing for Injection Drug Users", or the "HIT IDU" initiative, an emergency physician (EP)-based hepatitis C virus (HCV) testing program. The objective of this study was to evaluate the outcomes of this clinical protocol. ⋯ Although the overall number of EP-based HCV tests performed was low, high rates of infection were identified, particularly among PWID. There were significant challenges with linkage to care.