The American journal of emergency medicine
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This study investigated the feasibility of using the Roth score in the emergency setting to make hospitalization or discharge decisions for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). ⋯ The Roth score (only counts) increased in discharged patients after AECOPD treatment. It appears to be a viable method for predicting hospitalization or discharge decisions in patients with AECOPD who present to the emergency department.
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Multicenter Study
Antiseizure medication practices in the adult traumatic brain injury patient population.
Antiseizure medication (ASM) use in traumatic brain injuries (TBI) reduces the risk of early post-traumatic seizure (PTS). Agent selection and dosing strategies remain inconsistent among trauma centers in the United States. ⋯ This multicenter, survey study, identified variances in practice for PTS prophylaxis for brain injured patients throughout the U.S. Interestingly, the overwhelming majority of trauma centers do not conform to the Brain Trauma Foundation guidelines and utilize LEV as their agent of choice. Further studies should evaluate ideal patient selection for PTS prophylaxis, optimal agent, and dosing schemes within this cohort.
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Heart failure (HF) is a common condition prompting presentation to the Emergency Department (ED) and is associated with significant morbidity and mortality. However, there is limited recent large-scale, robust data available on the admission rates, evaluation, and treatment of HF in the ED setting. ⋯ HF represents a common reason for ED presentation, with the majority of patients being admitted. All patients received diuresis in the ED, with the majority receiving intravenous diuresis with furosemide. Approximately one-quarter received nitroglycerin with the sublingual/oral route being most common. These findings can help inform health policy initiatives, including admission decisions and evidence-based medication administration.
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Case Reports
Rectus sheath nerve block for analgesia & incarcerated hernia reduction in the emergency department.
Patients who present to the emergency department (ED) with incarcerated or strangulated ventral hernias are often in significant pain. Furthermore, even with procedural sedation, reduction itself also causes substantial pain. Hernias that cannot be reduced at the bedside with intravenous opioids or procedural sedation will require emergent surgery, which contributes to morbidity and mortality, especially in high-risk populations. ⋯ Ultrasound can visualize and diagnose an incarcerated hernia, and a bilateral rectus sheath block can be performed in the ED to anesthetize the peritoneal wall, paralyze abdominal musculature, and achieve nearly painless hernia reduction.
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Observational Study
Operational outcomes of community-to-academic emergency department patient transfers.
Many patients require inter-hospital transfer (IHT) to tertiary Emergency Departments (EDs) to access specialty services. The purpose of this study is to determine operational outcomes for patients undergoing IHT to a tertiary academic ED, with an emphasis on timing and specialty consult utilization. ⋯ Transferred patients represented a larger proportion of ED volume during evening and overnight hours, received more consults, and had higher likelihood of admission. Consults for transfers were disproportionately surgical subspecialties, though few patients went directly to a procedure. These findings may have operational implications in optimizing availability of specialty services across regionalized health systems.