The American journal of emergency medicine
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Multicenter Study
Emergency department utilization for mental health conditions before and after the COVID-19 outbreak.
The outbreak of COVID-19 disrupted lives across the United States. Evidence shows that such a climate is deleterious to mental health and may increase demand for mental health services in emergency departments. The purpose of this study was to determine the difference in emergency department utilization for mental health diagnoses before and after the COVID-19 surge. ⋯ The emergency department is an important community resource for the identification and triage of mental health emergencies. This role is even more important during disasters and extended crises, making it imperative that emergency departments employ experienced mental health staff. This study provides a comparison of emergency department utilization for mental health diagnoses before the pandemic and during the spring 2020 surge and may serve as a useful guide for hospitals, health systems and communities in future planning.
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Review Case Reports
Acute myocardial infarction from embolization of Lambl's excrescences: A case report.
While coronary artery embolism remains an infrequent cause of myocardial infarction (MI), it may present in patients at otherwise low risk for coronary artery disease. When clinicians apply typical risk stratification in these cases, they may be led away from a full evaluation for acute coronary syndrome (ACS). A diagnosis of MI in an otherwise healthy patient should prompt consideration of embolic sources, including Lambl's excrescences (LEs), and echocardiographic evaluation may be necessary to make a final diagnosis. We present a case of LEs in an otherwise healthy 43-year-old male presenting with chest pain and elevated cardiac enzymes, and also review the cases of this rare event found in the literature.
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Multicenter Study Observational Study
Accidental hypothermia: Factors related to a prolonged hospital stay - A nationwide observational study in Japan.
The incidence of accidental hypothermia (AH) is low, and the length of hospital stay in patients with AH remains poorly understood. The present study explored which factors were related to prolonged hospitalization among patients with AH using Japan's nationwide registry data. ⋯ Frailty, indoor situation, alcohol intoxication, pH value, potassium level, and DIC score were factors contributing to prolonged hospitalization in patients with AH. Preventing frailty may help reduce the length of hospital stay in patients with AH. In addition, measuring the pH value and potassium level by an arterial blood gas analysis at the ED is recommended for the early evaluation of AH.
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Multicenter Study
Antithrombotic regimens and need for critical care interventions among patients with subdural hematomas.
Antithrombotic-associated subdural hematomas (SDHs) are increasingly common, and the possibility of clinical deterioration in otherwise stable antithrombotic-associated SDH patients may prompt unnecessary admissions to intensive care units. It is unknown whether all antithrombotic regimens are equally associated with the need for critical care interventions. We sought to compare the frequency of critical care interventions and poor functional outcomes among three cohorts of noncomatose SDH patients: patients on no antithrombotics, patients on anticoagulants, and patients on antiplatelets alone. ⋯ Isolated antiplatelet use is not a significant predictor of need for critical care interventions or poor functional outcome among SDH patients and should not be used as a criterion for triage to the intensive care unit.
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Review
Pulmonary arterial hypertension in the emergency department: A focus on medication management.
Pulmonary arterial hypertension (PAH) is a chronic progressive incurable condition associated with a high degree of morbidity and mortality. With over five drug classes FDA approved in the last decade, the significant advancements in the pharmacologic management of PAH has improved long-term outcomes. ⋯ Given these consequences, PAH medications are classified as high-risk, and the transitions of care process to and from the hospital setting are a vulnerable area for medication errors in this population. Thus, it is crucial for the emergency department provider to appropriately identify, manage, and triage these patients through close collaboration with a multidisciplinary team to ensure safe and effective medication management for PAH patients in the acute care setting.