The American journal of emergency medicine
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Treating patients with acute heart failure is difficult at the local hospitals in medically depopulated areas where cardiologists are generally absent. These patients require long-distance and time-consuming transportation to the intensive care units. It is well known that tolvaptan is effective for the treatment of congestive heart failure, but the effect of prehospital tolvaptan use in patients is not well evaluated. The aim of this study was to evaluate the efficacy and safety of prehospital tolvaptan use in patients with acute congestive heart failure who require long-distance and time-consuming transportation. ⋯ The use of tolvaptan in patients with acute heart failure requiring long-distance transport is safe and may show better clinical course compared with conventional therapies.
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Acute flank pain associated with hematuria and unilateral hydronephrosis is a classic presentation for an obstructing ureteral stone. However, in the setting of hemorrhagic cystitis, blood can acutely obstruct the distal ureter and infrequently result in hydronephrosis. ⋯ Her symptoms resolved, urine cultures showed no growth, and her outpatient follow-up was unremarkable. We suspect given the acute onset of right obstructive uropathy, an unremarkable CT just hours earlier, and the brief nature of her symptoms, that blood obstructed her distal UVJ leading to acute and transient obstructive uropathy.
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In emergency medical services (EMS), response time is a key factor that shows the performance of the system. This factor is composed of two parts including activation time and travel time. The activation time of an emergency call is the time a call center spends on taking an incoming call for EMS and decides whether an ambulance should be dispatched or the emergency can be resolved by giving some medical advices. ⋯ This work is an example of the tremendous positive impact that the application of queuing theory and mathematical modeling can have. The proposed framework can significantly decrease the cycle time and increase the ambulance coverage level. The findings of this study help the policy makers of EMS centers with evaluating the performance of their systems and determining the optimal number of operators and locations of ambulances in a way that enhances the quality of emergency services.
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Sepsis is a leading cause of mortality with more than 700,000 hospitalizations and 200,000 deaths annually in the United States. Early recognition of sepsis is critical for timely initiation of treatment and improved outcomes. We sought to evaluate. in-hospital mortality rates of patients diagnosed with sepsis before and after implementation of emergency department (ED) sepsis teams. ⋯ Implementation of ED sepsis teams decreased inpatient hospital mortality rates, ED length of stay and hospital length of stay.
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Observational Study
Impact of COVID-19 lockdown on self-harm and violence among patients presenting to the emergency department.
Considering the resurgence of COVID19 and the rapid spread of new and deadlier strains across the globe understanding the incidence and pattern of violence and self harm tendencies during this period might help in formulating better contingency plans for future lockdowns. A deeper look at the available data shows that there is a significant dearth of research into self-harm & violence during the COVID-19 pandemic. ⋯ Increase in the incidence of cases of self-harm and violence reported to the ED was noted during the lockdown period. Upgradation of health-care and law enforcement infrastructure maybe needed to deal with similar circumstances in a more efficient manner.