The American journal of emergency medicine
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Multicenter Study
Methods of laceration closure in the ED: A national perspective.
Laceration closure is one of the most common procedures performed in the emergency department (ED). While sutures and staples have been the traditional wound closure device, topical skin adhesives (TSA) were introduced in the United States 20 years ago as a non-invasive alternative for simple, low-tension wounds. We determined which closure devices were used to close ED lacerations and explored patient and provider characteristics associated with choosing TSA. We also tested the hypothesis that use of TSA would be associated with shorter ED length of stay (LOS) than sutures/staples. ⋯ Topical skin adhesives are used in about 1 of 4 wound closures in the ED. Use of TSA did not differ based on demographic characteristics or wound site. Use of TSA is associated with a shorter ED LOS than sutures/staples.
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Multicenter Study
Impact of trauma level designation on survival of patients arriving with no signs of life to US trauma centers.
Trauma level designation and verification are examples of healthcare regionalization aiming at improving patient outcomes. This study examines impact of Trauma Levels on survival of patients arriving with "no signs of life" to US trauma centers. ⋯ Patients presenting without signs of life to Level II trauma centers had higher survival to hospital discharge compared to Level I and Level III centers. These findings can guide future prehospital triage criteria of trauma patients in organized Emergency Medical Services (EMS) systems and highlight the need for more outcome research on trauma systems.
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Review
Interventions to improve older adults' Emergency Department patient experience: A systematic review.
To summarize interventions that impact the experience of older adults in the emergency department (ED) as measured by patient experience instruments. ⋯ While all studies reported an outcome of patient experience, there was significant heterogeneity in the tools used to measure it. The very low certainty in the evidence available highlights the need for more reliable tools to measure patient experience and studies designed to measure the effect of the interventions.
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The aim of this study is to compare a point-of-care (POC) analysis, Enterprise POC (epoc), using the capillary blood obtained from skin puncture with conventional laboratory tests using arterial and venous blood in hypotensive patients. ⋯ Most parameters, except pO2, measured by the epoc system using the capillary blood in hypotensive patients were equivalent to or correlated with those measured by the reference analyzers.
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Electrical cardioversion (ECV) is the recommended treatment for atrial fibrillation (AFib) in critically ill patients, despite lacking data showing hemodynamic benefits of restoring sinus rhythm in this setting. The aim of this study was to assess the hemodynamic effect of successful ECV in a cohort of hemodynamically unstable critically ill patients. ⋯ ECV is associated with a large proportion of hemodynamic non-responders and a numerically modest, non-significant hemodynamic improvement in critically ill patients with new-onset AFib.