The American journal of emergency medicine
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Randomized Controlled Trial
Shenfu injection for improving cellular immunity and clinical outcome in patients with sepsis or septic shock.
To assess the efficacy of Shenfu injection (SFI) for enhancing cellular immunity and improving the clinical outcomes of patients with septic shock. ⋯ These findings suggest that SFI can enhance the cellular immunity of patients with septic shock and could be a promising adjunctive treatment for patients with septic shock.
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The HEART Pathway is a diagnostic protocol designed to identify low-risk patients presenting to the emergency department with chest pain that are safe for early discharge. This protocol has been shown to significantly decrease health care resource utilization compared with usual care. However, the impact of the HEART Pathway on the cost of care has yet to be reported. ⋯ Using the HEART Pathway as a decision aid for patients with undifferentiated chest pain resulted in significant cost savings.
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Timely transfer and percutaneous coronary intervention (PCI) with or without thrombolysis are recommended by the American Heart Association (AHA) to care for ST-segment elevation myocardial infarction (STEMI) patients who present first to a non-PCI-capable hospital. This study was to evaluate the impact on in-hospital mortality of the compliance with guidelines regarding to the time of PCI for patients with STEMI who were transferred to a capable PCI hospital. ⋯ Among the patients who were transferred for STEMI care, undergoing PCI as recommended by the AHA was not associated with a mortality benefit, but the patients whose symptom onset to hospital arrival time was within 30 minutes showed an association between compliance and lower mortality.
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Patients presenting to the emergency department (ED) with altered mental status and alcohol intoxication can clinically resemble patients with an intracranial hemorrhage. Although intracranial hemorrhage is quickly excluded with a head computed tomographic (CT) scan, it is common practice to defer imaging and allow the patient to metabolize to spare ED resources and minimize radiation exposure to the patient. Although this reduces unnecessary scans, it may delay treatment in patients with occult intracranial hemorrhage, which some fear may increase morbidity and mortality. We sought to evaluate the safety of deferred CT imaging in these patients by evaluating whether time to scan significantly affects the rate of neurosurgical intervention. ⋯ Routine CT scanning of alcohol-intoxicated patients with altered mental status is of low clinical value. Deferring CT imaging while monitoring improving clinical status appears to be a safe practice.
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Observational Study
Cardiology consultation reduces provocative testing rates in an ED observation unit.
In evaluating patients with chest pain, emergency department observation units (EDOUs) may use a staffing model in which emergency physicians determine patient testing (EP model) or a model similar to a chest pain unit (CPU) in which cardiologists determine provocative testing (CPU model). ⋯ An EDOU model that used mandatory cardiology consultation resulted in decreased provocative testing, particularly among low-risk chest pain patients. Future research should explore the cost-effectiveness of this model.