The American journal of emergency medicine
-
Letter Randomized Controlled Trial
Time to successful completion of simulated pediatric lumbar puncture in lateral vs seated position: Comparison in novice providers.
-
Investment in violence prevention programs is hampered by lack of clearly identifiable stakeholders with a financial stake in prevention. We determined the total annual charges for the acute care of injuries from interpersonal violence and the shift in financial responsibility for these charges after the Medicaid expansion from the Affordable Care Act in 2014. ⋯ After Medicaid expansion, taxpayers are now accountable for nearly half of the $10.7 billion in annual charges for the acute care of violent injury in the U.S. These findings highlight the benefit to state Medicaid programs of preventing interpersonal violence.
-
Speckle tracking echocardiography (STE) is a novel technology that measures regional wall-motion abnormalities that may speed diagnosis and intervention of acute coronary occlusion in Emergency Department (ED) patients with non-ST elevation ACS (NSTE-ACS). STE provides an objective measurement of myocardial strain that is superior to visual assessment of wall motion when performed as part of a point-of-care (POC) echocardiogram. We determined the feasibility and preliminary accuracy of POC STE operated by emergency providers when compared to comprehensive echocardiography or final diagnosis of ACS. ⋯ STE is a potentially feasible adjunct to standard bedside echocardiography in ED patients with suspected ACS when operated by experienced ultrasound-trained physicians in the ED. This data shows STE performed by emergency providers is not yet sensitive enough alone to diagnose ACS, and has low accuracy when compared to comprehensive echocardiography. However, the PPV and specificity improve when performed by expert ultrasound-trained providers. STE should be considered for inclusion in the Emergency Ultrasound Fellowship curriculum.
-
Cardio Pulmonary Resuscitation (CPR) for traumatized patients in the field portends poor survival but the outcome of trauma patients who arrive in-extremis and undergo CPR shortly after arrival has not been well studied. The purpose of our review is to evaluate survival to discharge for trauma patients with CPR from 1 to 120 minutes (min) after arrival. ⋯ Trauma patients who undergo CPR shortly after arrival have a survival rate of (4.3%-36.4%). Over one-third of blunt and penetrating injuries and low ISS who had CPR from 61 to 120 min after arrival survived. Trauma patients who arrest shortly after arrival warrant an aggressive approach.
-
Community-acquired pneumonia (CAP) is a common presentation to the emergency department (ED) and has high mortality rates. The aim of our study is to investigate the risk stratification and prognostic prediction value of precalcitonin (PCT) and clinical severity scores on patients with CAP in ED. ⋯ Serum PCT is a valuable single predictor for SCAP. SOFA is superior in prediction of 28-day mortality. Combination of PCT and SOFA could improve the performance of single predictors. More further studies with larger sample size are warranted to validate our results.