The American journal of emergency medicine
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Review Meta Analysis
Norepinephrine versus epinephrine for hemodynamic support in post-cardiac arrest shock: A systematic review.
The preferred vasopressor in post-cardiac arrest shock has not been established with robust clinical outcomes data. Our goal was to perform a systematic review and meta-analysis comparing rates of in-hospital mortality, refractory shock, and hemodynamic parameters in post-cardiac arrest patients who received either norepinephrine or epinephrine as primary vasopressor support. ⋯ The vasopressor with the best mortality and hemodynamic outcomes in post-cardiac arrest shock remains unclear. Randomized studies are crucial to remedy this.
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Randomized Controlled Trial
A novel CPR-assist device vs. established chest compression techniques in infant CPR: A manikin study.
Guidelines for infant CPR recommend the two-thumb encircling hands technique (TTT) and the two-finger technique (TFT) for chest compression. Some devices have been designed to assist with infant CPR, but are often not readily available. Syringe plungers may serve as an alternative infant CPR assist device given their availability in most hospitals. In this study, we aimed to determine whether CPR using a syringe plunger could improve CPR quality measurements on the Resusci-Baby manikin compared with traditional methods of infant CPR. ⋯ The performance of chest compression depth and re-rebound ratio was statistically different among the three groups. TTT has good ECC depth and depth accuracy but poor recoil. TFT is the complete opposite. SPT can achieve a depth close to TTT and has a good recoil performance as TFT. Regarding comprehensive performance, SPT obtains the highest QCPR score, and SPT is also less fatigued. SPT may be an effective alternative technique for infant CPR.
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Rising length of stay and inpatient boarding in emergency departments have directly affected patient satisfaction and nearly all provider-to-patient care metrics. Prior studies suggest that ED observation has significant clinical and financial benefits including decreasing hospitalization and length of stay. ED observation is one method long employed to shorten ED length of stay and to free up inpatient beds, yet many patients continue to be admitted to the hospital with an average hospital length of stay of only one day. ⋯ Our data suggest that increasing the total number of patients placed into observation by 21% correlated with a relative increase in admission rates from ED observation by 18%. This would suggest that our efforts to potentially include more patients into our observation program led to a significant increase in subsequent admission rates. There is likely a balance that must be struck between under- and over-utilization of ED observation, and expanding ED observation may be an effective solution to hospital boarding and ED overcrowding.
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The manual recording of electronic health records (EHRs) by clinicians in the emergency department (ED) is time-consuming and challenging. In light of recent advancements in large language models (LLMs) such as GPT and BERT, this study aimed to design and validate LLMs for automatic clinical diagnoses. The models were designed to identify 12 medical symptoms and 2 patient histories from simulated clinician-patient conversations within 6 primary symptom scenarios in emergency triage rooms. ⋯ This paper highlights the potential of LLMs for automatic EHR recording in Korean EDs. The KLUE-RoBERTa-based model demonstrated superior classification performance. Furthermore, XAI using SHAP provided reliable explanations for model outputs. The reliability of these explanations was confirmed by a Turing test.