The American journal of emergency medicine
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To evaluate whether a fast-track intervention program will reduce time-lags of patients with STEMI considering minority groups, various socioeconomic status (SES) and clinical risk factors. ⋯ The fast track intervention was associated with less time at ED and to cardiac reperfusion. Yet, sociodemographic bias was present. Our findings highlight the need for the healthcare profession to address the role of biases in disparities in healthcare.
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Observational Study
Effects of emergency department boarding on mortality in patients with ST-segment elevation myocardial infarction.
Patients with ST-segment elevation myocardial infarction (STEMI) are sometimes boarded in the emergency department (ED) after percutaneous coronary intervention (PCI). We evaluated the effects of direct and indirect admission to the CCU on mortality and the effect on length of stay (LOS) in patients with STEMI. ⋯ This study suggests that direct admission after PCI and indirect admission was not associated with mortality in patients with STEMI. In addition, the stay in ED also appears to be associated with the duration of stay under critical care.
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Carbon monoxide (CO) poisoning is one of the leading causes of preventable death in the world. Our primary objective was to identify and treat individuals who are unaware of their exposure to carbon monoxide in emergency departments (EDs). Our secondary goal was to reduce the costs of diagnosis and treatment by preventing unnecessary diagnostic testing in EDs. ⋯ The use of noninvasive pulse CO-oxymeter might reduce the morbidity and mortality associated with occult CO poisoning in patients presented with suspected CO poisoning in emergency settings.
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A previously healthy 60-year-old man presented to our emergency department with anaphylactic shock. We initiated fluid resuscitation with Ringer's lactate solution; injected 0.3 mg epinephrine intramuscularly; and administered d-chlorpheniramine maleate 5 mg, famotidine 20 mg, and methylprednisolone 80 mg intravenously. His symptoms resolved within 10 min. ⋯ Thus, physicians should not hesitate to use epinephrine for patients who present with life-threatening conditions due to suspected anaphylaxis. Physicians should observe patients closely following epinephrine administration, and if they develop some symptoms, should carefully examine the patients because the treatments of anaphylaxis and myocardial ischemia differs. Physicians should be alert to the risk of myocardial ischemia after treatment of anaphylaxis, especially following epinephrine administration.