The American journal of emergency medicine
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Early identification of ST elevation MI (STEMI) in emergency departments (ED) via electrocardiogram (ECG) expedites intervention. While screening of all ED chest pain ECGs should be obtained within 10 minutes per the American Heart Association, 40% of all ECGs are software-analyzed as "Normal" or "Otherwise Normal." However, the reliability of this analysis and the time for confirmation read are uncertain. This study investigates the time necessary for Patient Care Technicians (PCTs) to deliver ECGs to ED attendings to confirm automated interpretation. ⋯ Screening of triage ECGs is time-intensive and compounds the frequency of physician interruptions. Although findings are not generalizable, the impact of these interruptions on patient care and safety is paramount and universal. Future directions include validating the reliability of "Normal" and "Otherwise Normal" ECG automated readings to obviate the need to interrupt ED physician for expedited screening confirmation.
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Chronic nitrous oxide abuse is a known cause of myeloneuropathy. Nitrous oxide irreversibly inactivates vitamin B12 causing demyelination of the dorsal spinal columns, clinically indistinguishable from that which is caused by vitamin B12 deficiency. ⋯ The patient reported daily use in excess of 500 nitrous oxide cartridges, also known as "whippits". Nitrous oxide myeloneuropathy should be included in the differential diagnoses for emergency medicine physicians when evaluating a patient with bilateral neurologic deficits and ataxia.
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Symptoms of COVID-19 vary in severity and presentation. When admitting patients to the hospital, it is desirable to isolate patients with COVID-19 from those without the disease. However, reliably identifying patients with COVID-19 in the emergency department before hospital admission is often limited by the speed and availability of testing. Previous studies determined a low lymphocyte count is commonly found in patients with COVID-19. We sought to explore the sensitivity of absolute lymphocyte count in patients presenting to the emergency department requiring subsequent hospitalization who were found to have COVID-19. ⋯ Knowing the sensitivity of absolute lymphocyte count in patients with COVID-19 may help identify patients who are unlikely to have the disease. Additionally, absolute lymphocyte count can be used as a marker of disease severity in patients with COVID-19.
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Observational Study
Reverse shock index multiplied by Glasgow coma scale as a predictor of massive transfusion in trauma.
Previous studies have identified that the reverse shock index multiplied by the Glasgow Coma Scale score (rSIG) is a good predictor of mortality in trauma patients. However, it is unknown if rSIG has utility as a predictor for massive transfusion (MT) in trauma patients. The present study evaluated the ability of rSIG to predict MT in trauma patients. ⋯ rSIG is a useful, rapid, and accurate predictor for MT, coagulopathy, in-hospital mortality, and 24- h mortality in trauma patients.
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During a novel virus pandemic, predicting emergency department (ED) volume is crucial for arranging the limited medical resources of hospitals for balancing the daily patient- and epidemic-related tasks in EDs. The goal of the current study was to detect specific patterns of change in ED volume and severity during a pandemic which would help to arrange medical staff and utilize facilities and resources in EDs in advance in the event of a future pandemic. ⋯ A significant reduction in ED volume during the COVID-19 pandemic was noted and a predictable pattern was found. This specific change in pattern in the ED volume may be useful for performing adjustments in EDs in the future during a novel virus pandemic. The severity of patients visiting the ED during epidemic periods was inconclusive.