The American journal of emergency medicine
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It is well documented that disparities in patient care based on race and ethnicity are prevalent in the emergency medical care setting. In most cases these evaluations are patient focused and outcome based. The timeliness of patient treatment in the emergency department (ED) is correlated with patient outcomes. In this study, we sought to evaluate whether the timeliness of care for patients with chest pain across stages of care was impacted by patient race. ⋯ Black patients have longer wait times for resident physician evaluation, advanced practice provider evaluation, attending physician evaluation, and ED disposition when presenting to the ED with chest pain.
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Observational Study
Association between patient age and pediatric cardiac arrest recognition by emergency medical dispatchers.
Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is an important prognostic factor in pediatric out-of-hospital cardiac arrest (OHCA). The recognition of cardiac arrest by dispatcher is a key factor for successful DA-CPR. In this study, we evaluated the association between pediatric age and dispatcher recognition. ⋯ Patients ages 7-18 years old were negatively associated with cardiac arrest recognition and DA-CPR instruction provision within optimal timeframes compared to those younger than one year old. Development of a tailored protocol could be considered according to age and cause of arrest for better dispatcher performance in pediatric OHCA patients.
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Randomized Controlled Trial
Dexamethasone and ketorolac compare with ketorolac alone in acute renal colic: A randomized clinical trial.
Multidrug pain control can be beneficial in relieving pain and limiting narcotic use in renal colic. The purpose of this study was to evaluate the effects of adding dexamethasone to ketorolac on pain control in acute renal colic. ⋯ In comparison with the patients who just received ketorolac, adding dexamethasone provided improved pain control after 30 min of therapy. Furthermore, it decreased opioid requirements and decreased an antiemetic need at the end of the study. Dexamethasone should be considered an important multimodal adjunct for controlling pain and nausea in renal colic.
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Contrast-enhanced magnetic resonance imaging (MRI) is the preferred imaging modality for diagnosing pyogenic spinal infection (PSI), but it is not always available. Our objective was to describe pyogenic spinal infection imaging characteristics in patients presenting to a community emergency department (ED) and estimate the computed tomography (CT) sensitivity for these infections. ⋯ Patients found to have vertebral osteomyelitis/discitis, septic facet, and paravertebral infections frequently had a SEA coinfection. CT interpretation by a neuroradiologist had moderate sensitivity for infections outside the spinal canal but had low sensitivity for SEA.