The American journal of emergency medicine
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Meta Analysis
Mobile integrated health-community paramedicine programs' effect on emergency department visits: An exploratory meta-analysis.
Mobile Integrated Health Community Paramedicine (MIH-CP) programs are designed to increase access to care and reduce Emergency Department (ED) and Emergency Medical Services (EMS) usage. Previous MIH-CP systematic reviews reported varied interventions, effect sizes, and a high prevalence of biased methods. We aimed to perform a meta-analysis on MIH-CP effect on ED visits, and to evaluate study designs' effect on reported effect sizes. We hypothesized biased methods would produce larger reported effect sizes. ⋯ Our data revealed MIH-CP programs were associated with a reduced risk of ED visits. Study design did not have a statistically significant influence on effect size, though it did influence heterogeneity. We would recommend future studies continue to use high levels of control to produce reliable data with lower heterogeneity.
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Multicenter Study
Risk factors, management, and outcomes in isolated parafalcine or tentorial subdural hematomas.
Indications for hospitalization in patients with parafalcine or tentorial subdural hematomas (SDH) remain unclear. This study derived and validated a clinical decision rule to identify patients at low risk for complications such that hospitalization can be avoided. ⋯ Retrospective Cohort Study.
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Cardiogenic shock (CS) is associated with high morbidity and mortality. In recent times, there is increasing interest in the role of angiotensin II in CS. We sought to systematically review the current literature on the use of angiotensin II in CS. ⋯ In this first systematic review of angiotensin II in CS, we note the early clinical experience. Angiotensin II was associated with improvements in MAP, decrease in vasopressor requirements, and minimal reported adverse events.
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Comparative Study Observational Study
Comparison of outcomes between observation and tube thoracostomy for small traumatic pneumothoraces.
Traumatic pneumothorax management has evolved to include the use of smaller caliber tube thoracostomy and even observation alone. Data is limited comparing tube thoracostomy to observation for small traumatic pneumothoraces. We aimed to investigate whether observing patients with a small traumatic pneumothorax on initial chest radiograph (CXR) is associated with improved outcomes compared to tube thoracostomy. ⋯ Select patients with small traumatic pneumothoraces on initial chest radiograph who were treated with observation experienced an average length of stay over two days shorter than those treated with tube thoracostomy. Outcomes were otherwise similar between the two groups suggesting that an observation-first strategy may be a superior treatment approach for these patients.
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Review Case Reports
The seven day itch: A delayed histamine reaction to stingray injury.
Stingray injuries are common presentations to emergency departments near warm coastal waters. Commonly reported injuries include puncture wounds, lacerations, and envenomations, the latter of which cause severe pain but are usually easily treated with warm water immersion. We report a case of delayed histamine reaction in a patient who sustained a stingray envenomation one week prior which we believe is the first such report in the medical literature but is found on discussion boards for those who have sustained stingray injuries. The literature on such envenomations is reviewed.