The American journal of emergency medicine
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Bacteremia is a common but critical condition with high mortality that requires timely and optimal treatment in the emergency department (ED). The prediction of bacteremia at the ED during triage and disposition stages could support the clinical decisions of ED physicians regarding the appropriate treatment course and safe ED disposition. This study developed and validated machine learning models to predict bacteremia in the emergency department during triage and disposition stages. ⋯ The Triage XGB model could be used to identify patients with a low risk of bacteremia immediately after initial ED triage. The Disposition XGB model showed excellent discriminative performance.
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Pneumomediastinum is a rare complication of substance use, likely due to a Valsalva maneuver after drug inhalation. There are no previously documented associations between pneumomediastinum and opioid use. ⋯ He required emergent surgical decompression with a "blowhole incision" to his anterior chest. Although a rare complication of polysubstance use, pneumomediastinum can progress to tension physiology, requiring prompt diagnosis and management.
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Observational Study
Association between emergency department modifiable risk factors and subsequent delirium among hospitalized older adults.
To evaluate the association between potential emergency department (ED)-based modifiable risk factors and subsequent development of delirium among hospitalized older adults free of delirium at the time of ED stay. ⋯ ED LOS and ED opioid use were not associated with higher risk of incident delirium in this cohort. Urinary catheterization in the ED was associated with an increased risk of subsequent delirium. These findings can be used to design ED-based initiatives and increase delirium prevention efforts.
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As foreign body airway obstruction (FBAO) can be life-threatening, it has to be promptly diagnosed and treated. We report a case series of three patients presenting to the emergency department with cardiac arrest due to FBAO. In each case, ventilation was difficult due to high airway resistance. ⋯ The life-saving benefits of bronchoscopy outweigh the small risks of complications such as bleeding, desaturation and pneumothorax. In the three cases, the removal of the obstructing material led to immediate improvements in oxygenation and ventilation. The patients had return of spontaneous circulation after cardiopulmonary resuscitation and definite airway control.