The American journal of emergency medicine
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Hypotension in the emergency department (ED) is known to be associated with increased mortality, however, the relationship between timing of hypotension and mortality has not been investigated. The objective of the study was to compare the mortality rate of patients presenting with hypotension with those who develop hypotension while in the ED. ⋯ This study demonstrated hypotension in the ED was associated with a very significantly increased risk of in-hospital mortality. However, there was no significant increase in mortality between those patients with hypotension on arrival those who develop hypotension while in the ED. These finding underscore the importance of careful hemodynamic monitoring for patients in the ED throughout their stay.
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This study evaluates the time to attempted patient contact for positive blood cultures in patients discharged from the Emergency Department (ED) resulting when an Emergency Medicine (EM) pharmacist is on-duty compared to off-duty. ⋯ In patients discharged from the ED with subsequent positive blood cultures, time to attempted patient contact was significantly shorter when a pharmacist was on-duty. Our data emphasizes the importance of having a standardized practice in place to optimize ED patient care and outcomes and the benefit of a pharmacist's involvement in the process.
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Prior studies identified increased penetrating trauma rates during the earlier phase of the COVID-19 pandemic, but there is limited study of penetrating trauma rates in 2021 or at a national level. We evaluated trends in prehospital encounters for penetrating trauma in 2020 and 2021 using a national database. ⋯ We identified elevated rates of trauma on 2020 that lasted until July of 2021 that was present in all US census regions.
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Renal infarction (RI) is rare but clinically important because the appropriate treatment depends on the time of diagnosis. RI is often misdiagnosed as acute pyelonephritis (APN) because both diseases have nonspecific symptoms such as flank pain and abdominal pain. We identified predictors for distinguishing RI from APN. ⋯ Male sex, AF, no CVAT, AST level > 21.50 U/L, CRP level < 19.75 mg/L, and no pyuria were significant factors that could distinguish RI from APN.
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Low back pain is among one of the most common presentations to the emergency department (ED). Regional anesthesia has recently gained traction as an option for analgesia in ED patients, especially in the wake of the opioid epidemic. ⋯ We describe a series of three cases of patients who presented to the ED with severe low back pain refractory to traditional therapy, successfully treated using lumbar ESPB. Lumbar ESPB may be an effective approach to achieving rapid analgesia in patients who present with low back pain who may otherwise be poor candidates for more traditional therapy, such as with opioids or NSAIDs, or who may have refractory pain despite use of these medications.