The American journal of emergency medicine
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Review
Ventricular assist device in the emergency department: Evaluation and management considerations.
Ventricular assist devices (VAD) are being used at increasing rates in patients with severe, end-stage heart failure. Specific indications include VAD placement as a bridge to cardiac function recovery, a bridge to cardiac transplantation, or destination therapy (long-term support for patients ineligible for transplant). The assessment and management of the VAD patient is rather complex, requiring a basic knowledge of device structure and function. This article reviews the basic structure and function, discusses the approach to the VAD patient in the ED, and reviews the more common presentations and complications encountered in these technology-complex patients who are critically ill at baseline.
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Multicenter Study
Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service.
Overcrowding in the emergency department (ED) has been associated with patient harm, yet little is known about the association between ED boarding and adverse hospitalization outcomes. We sought to examine the association between ED boarding and three common adverse hospitalization outcomes: rapid response team activation (RRT), escalation in care, and mortality. ⋯ Within the first 24h of hospital admission to a general medicine service, adverse hospitalization outcomes are rare and not associated with ED boarding.
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Clinical Trial
Emergency medical technician-performed point-of-care blood analysis using the capillary blood obtained from skin puncture.
Comparing a point-of-care (POC) test using the capillary blood obtained from skin puncture with conventional laboratory tests. ⋯ Most parameters, except only pO2, measured by the epoc were equivalent to or correlated with those from the reference method.
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This study is to present the diagnostic values of the novel sonographic visualization of the inferoposterior thoracic wall (VIP) and boomerang signs in detecting right pleural effusion by sonologists with little to no experience in ultrasound. ⋯ Despite inexperience in sonography, the novel VIP and boomerang signs show high diagnostic values in detecting right pleural effusion compared to the traditional methods.
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Comparative Study Observational Study
Analgosedative interventions after rapid sequence intubation with rocuronium in the emergency department.
The use of etomidate and rocuronium for rapid sequence intubation (RSI) results in a duration of paralysis that exceeds the duration of sedation. The primary objective of this study was to compare the number of analgosedative (AGS) interventions early versus late post-RSI, with this drug combination. The secondary objective was to descriptively assess time to first AGS intervention. ⋯ When rocuronium was used for RSI in the ED there was no delay in provision of post-intubation sedation or analgesia, after a pharmacy-led educational program.