The American journal of emergency medicine
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Observational Study
Differentiating type 1 and 2 acute myocardial infarctions using the N-terminal pro B-type natriuretic peptide/cardiac troponin T ratio.
Differentiation of type 1 (T1MI) from type 2 myocardial infarction (T2MI) is important as recommended treatments for each differ. Patients with T2MI may have more/earlier cardiac wall stress resulting in an increased N-terminal pro B-type natriuretic peptide (NT-proBNP)/cTnT generation 5 ratio (cTnT Gen 5). ⋯ The clinical determination of whether an AMI is type 1 or 2 is difficult as the ED patient characteristics of each are similar. The NT-proBNP/cTnT Gen 5 ratio can aid in making this differentiation. Additional multicenter trials are needed to validate our results.
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Observational Study
Low-level troponin elevations following a reduced troponin I cutoff: Increased resource utilization without improved outcomes.
The study sought to evaluate changes in mortality and resource utilization in patients with low level troponin elevations following a reduction in the cutoff for normal troponin I (TnI) from 0.5 ng/mL to the 99th percentile (0.06 ng/mL). ⋯ A reduction in the TnI cutoff to the 99th percentile did not change mortality or rates of coronary intervention in ED patients with low level troponin elevations, but significantly increased the use of cardiology resources.
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Observational Study
Management of dyspepsia-The role of the ED Observation unit to optimize patient outcomes.
Dyspepsia is a common complaint that can confer significant burden on one's quality of life and may also be associated with serious underlying conditions. The objective of this study was to determine if patients admitted to the emergency department observation unit (EDOU) for severe or persistent dyspepsia would have cost effective management in terms of investigations performed, length and cost of hospital stay. The secondary objective was to determine if any patient characteristics could predict a need for admission to the inpatient unit. ⋯ The EDOU is an appropriate setting to facilitate investigations and treatment of patients with dyspepsia with considerable bed-saved days.
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Respiratory Therapists (RTs) are some of the first staff to arrive at in-hospital incidents where cardiopulmonary resuscitation (CPR) is needed, yet at some facilities, their ability to intubate is limited by hospital scope of practice. During the intubation process, CPR is often interrupted which could potentially increase the likelihood of adverse patient outcomes. Training RTs to secure the airway using non-intubation methods may reduce or eliminate time for CPR interruptions and allow for earlier continuous/uninterrupted chest compressions. ⋯ We propose that more RTs should be trained to insert supraglottic airway devices during inpatient CPR events.
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We examine recent trends in U.S. emergency department (ED) and hospital care for stroke and transient ischemic attack (TIA). ⋯ Over this nine-year study period, the average age of stroke & TIA patients was unchanged in U.S. hospitals; however, the proportion with Medicaid insurance increased considerably. Stroke incidence increased while TIA decreased slightly. Full inpatient hospitalizations are declining for both conditions, while transfers are on the rise. Average inpatient costs increased dramatically for all three conditions while mortality for stroke & ICH fell significantly.