The American journal of emergency medicine
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Comparative Study
Comparison of physician-staffed helicopter with ground-based emergency medical services for trauma patients.
Few studies have discussed whether physician-staffed helicopter emergency medical services (HEMS) provide temporal and geographical benefits for patients in remote locations compared to ground emergency medical services (GEMS). Our study seeks to clarify the significance of HEMS for patients with severe trauma by comparing the mortality of patients transported directly from crash scenes by HEMS or GEMS, taking geographical factors into account. ⋯ HEMS may provide equal treatment opportunities and minimize trauma deaths for patients transported from a greater distance to an emergency medical center compared to GEMS for patients transported from nearby regions.
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Comparative Study
Practical assessment of different saw types for field amputation: A cadaver-based study.
Field amputation can be life-saving for entrapped patients requiring surgical extrication. Under these austere conditions, the procedure must be performed as rapidly as possible with limited equipment, often in a confined space, while minimizing provider risk. The aim of this study was to determine the ideal saw, and optimal approach, through bone or joint, for a field amputation. ⋯ The speed, precision, safety, space required, as well as the adjustable blade of the oscillating saw make it ideal for a field amputation. A Gigli saw is an excellent backup for when electrical tools cannot be used. Through bone amputation is faster than a through joint amputation.
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Observational Study
Serum cholesterol as a predictor of mortality among the elderly patients with pneumonia in the emergency department.
Reduced cholesterol levels are associated with poor outcomes in critically ill patients. However, the effect of reduced cholesterol levels on the prognosis of patients with community-acquired pneumonia (CAP) is unclear. This study aimed to investigate the association between serum total cholesterol levels and the clinical outcomes of elderly patients with CAP. ⋯ A decreased level of total cholesterol was associated with increased short-term mortality in elderly patients with CAP. Initial total cholesterol levels may be a useful biomarker to predict the outcome of patients with CAP.
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This study aimed to examine the use of point-of-care ultrasonography (POCUS) in detecting diaphragmatic dysfunction (DD) and evaluate its ability to predict noninvasive mechanical ventilation (NIV) failure in patients presented to the emergency department with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). ⋯ DD has high sensitivity and specificity in predicting NIV failure in patients admitted to the emergency department with AECOPD. DD can be assessed by an experienced clinician noninvasively using POCUS in emergency departments.
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Observational Study
Outcomes of a novel ED observation pathway for mild traumatic brain injury and associated intracranial hemorrhage.
Recent studies have shown that the majority of non-anticoagulated patients with small subdural or subarachnoid intracranial hemorrhage (ICH) in the setting of mild traumatic brain injury do not experience clinical deterioration or require neurosurgical intervention. We implemented a novel ED observation pathway to reduce unnecessary admissions among patients with ICH in the setting of mild TBI (complicated mild TBI, cmTBI). ⋯ ED observation for patients with cmTBI resulted in an 82% pathway completion rate, including outside hospital transfers. These results suggest that patients with cmTBI may be safely discharged from the ED after a brief period of observation. Our pathway protocol and implementation involved neurosurgical consultation and the ability to perform repeat neurologic exams in the ED. Future studies should examine the feasibility of non-transfer protocols for appropriately selected patients and access to neurosurgical expertise in the community setting.