The American journal of emergency medicine
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Review Meta Analysis
Impact of triage liaison provider on emergency department throughput: A systematic review and meta-analysis.
Emergency department (ED) overcrowding is linked to poor outcome and decreases patient satisfaction. Strategies to control Emergency department (ED) overcrowding has been subject of research. ⋯ Implementation of TLP can decrease the rate of LWBS however this review is inconclusive about the effect of TLP on ED-LOS due to the high heterogeneity observed in the literature.
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Multicenter Study Observational Study
Validation of the PECARN head trauma prediction rules in Japan: A multicenter prospective study.
Head trauma in children is one of the most common causes for emergency department visits. Although most trauma cases are minor, identifying those patients who have clinically important traumatic brain injury (ciTBI) is challenging. The Pediatric Emergency Care Applied Research Network (PECARN) head trauma prediction rules identifying children who do not require cranial computed tomography (CT) were validated and are used all over the world. However, these rules have not been validated with large cohort multicenter studies in Asia. ⋯ The PECARN head trauma prediction rules seemed to be safely applicable to Japanese children. Further studies are needed to determine safety in hospitals where physicians do not have expertise in managing children.
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Evaluate an established scribe program on throughput and revenue capture in an Emergency Department (ED) undergoing an EMR transition. ⋯ A scribe's ability to mitigate operational inefficiencies introduced by an EMR transition seems limited in an academic hospital. Previous research highlighting the impact of scribes on revenue was not replicated during this study.
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Case Reports
ST segment elevation in an adult chest pain patient: A case of coronary artery vasospasm.
Chest pain is one of the most common symptoms of patients presenting to the emergency department (ED) in the United States, accounting for up to eight million cases annually. We present a 55-year-old male who was brought in to the ED with sudden onset chest pain and was found to have ST-segment elevations in the infero-lateral leads on electrocardiogram (ECG). These changes resolved with nitroglycerin. ⋯ Calcium channel blocker was prescribed with good symptom relief. The most important teaching point is, coronary vasospasm as a cause of ST-segment elevation is missed frequently and should be considered among the differentials in patients presenting with chest pain. Nitrates and/or calcium channel blockers along with avoidance of triggers can help in symptom management.
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This paper reports a case of paradoxical embolism of right heart thrombi visualized on transesophageal echocardiography during cardiopulmonary resuscitation (CPR). CPR may cause a right-to-left shunt by producing a sudden increase in right atrial pressure during the compression phase. In cardiac arrest patients with right heart thrombi who have received CPR, systemic embolization can occur owing to paradoxical embolism.