The American journal of emergency medicine
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Observational Study
Heart failure education in the emergency department markedly reduces readmissions in un- and under-insured patients.
Heart failure (HF) readmissions are a longstanding national healthcare issue for both hospitals and patients. Our purpose was to evaluate the efficacy of a structured, educational intervention targeted towards un- and under-insured emergency department (ED) HF patients. ⋯ An ED educational intervention markedly decreases ED and hospital readmissions in un- and under-insured HF patients.
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Shared decision-making (SDM) has been studied in the emergency department (ED) in relation to hospital admissions but not for CT scan utilization. CT scans are a common imaging modality with high accuracy that emit considerable ionizing radiation. This study has three aims: to measure provider and patient preference for SDM; to evaluate patient involvement in the decision to order a CT scan; and to determine the association between patient involvement and CT utilization. ⋯ High rates of provider and patient preference to use SDM for treatment plans were reported but providers were rarely observed engaging patients with abdominal pain in the decision to order a CT scan.
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Observational Study
Effect of regional cerebral oximetry to estimate neurologic prognostic outcomes in patients administered targeted temperature management.
The aim of our study is to research the role and efficacy of cerebral oximetry in predicting neurologic prognosis when applied during TTM to patients experiencing coma after CA. ⋯ There is no significant correlation between rSO2 values and neurologic outcomes. Multimodal monitoring methods may be useful and further studies with a larger patient population are necessary in this area.
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Babesiosis is an infectious disease caused by protozoa of the genus Babesia which is primarily transmitted by tick vectors. Most cases are asymptomatic or only mild to moderate, but some cases may be severe causing death. A 57 year old male with no reported travel outside the country was escorted by Emergency Medical Services to our Pennsylvania hospital in July of 2018 presenting with hypoglycemia, jaundice, and hypotension. ⋯ The patient was ultimately transferred to a tertiary care center for exchange transfusion therapy and veno-arterial extracorporeal membrane oxygenation support, but expired 36 h after presentation. Current CDC data reflects a steady rise of tick borne disease in the United States, but as of 2016 there have been no reported cases of babesiosis in the state of Pennsylvania, let alone fatalities. Clinicians need to be aware of the risk of fulminant illness when practicing in known endemic regions.
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Shoulder pain and weakness are common presenting Emergency Department complaints. Patients are often diagnosed with fractures, dislocations, bursitis, and muscle strain. Here we present an unusual cause of shoulder pain in an athletic and otherwise healthy young patient that does not respond to typical treatments for musculoskeletal pain.