The American journal of emergency medicine
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Multicenter Study
Relationship between the hemoglobin level at hospital arrival and post-cardiac arrest neurologic outcome.
The hemoglobin (Hb) level is an essential determinant of oxygen delivery. The restoration of blood perfusion to vital organs and the capacity for oxygen delivery may be associated with ischemia and reperfusion injuries during cardiac arrest and after cardiac arrest. However, whether the Hb level is associated with neurologic outcome in post-cardiac arrest patients remains unclear. ⋯ A higher Hb level at the time of hospital arrival was associated with a favorable short-term neurologic outcome among post-cardiac arrest patients with a presumed cardiac etiology.
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The objective of the study was to compare errors in the emergency department (ED) with pharmacists present (PPs) for resuscitations and traumas vs with pharmacists absent (PAs). Our hypothesis was that errors would be significantly fewer during PP than PA times. We also hypothesized that times with PP would affect patients greater when disposition was to more critical areas (intensive care unit, or ICUs). ⋯ With pharmacists absent, over 13 times more errors are recorded in our ED than with pharmacists present. An on-site pharmacist in the ED may be helpful in reducing medical errors.
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Comparative Study
Acute heart failure registry from high-volume university hospital ED: comparing European and US data.
Acute heart failure (AHF) is associated with a poor prognosis. ⋯ The patient's blood pressure, ejection fraction, and hemoglobin values, at admission, were identified as the strongest predictors of all-cause mortality. In AHF not triggered by acute MI, long-term use of statins may be associated with reduced survival. The prevalence of diastolic AHF is low. The American AHF population had similar baseline characteristics; needed fewer intensive care unit admissions; had a better 30 days of prognosis, lower incidence of MI, and de novo AHF diagnoses. In a similar subgroup, we observed similar incidences of inotropic support and mechanical ventilation. Our results could not be generalized to all patients with AHF admitted to US EDs.
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The Glasgow-Blatchford Bleeding Score (GBS) and Rockall Score (RS) are clinical decision rules that risk stratify emergency department (ED) patients with upper gastrointestinal bleeding (UGIB). We evaluated GBS and RS to determine the extent to which either score identifies patients with UGIB who could be safely discharged from the ED. ⋯ Although GBS outperformed pre-endoscopy RS, the prognostic accuracy of GBS and post-endoscopy RS was similarly high. The specificity of GBS and RS was insufficient to recommend use of either score in clinical practice.
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The anterolateral abdominal wall is innervated by the T7 to L1 anterior rami, whose nerves travel in the fascial plane between the internal oblique and transversus abdominus muscles, known as the transversus abdominus plane (TAP). Ultrasound-guided techniques of regional anesthesia that target the TAP are increasingly relied upon by anesthesiologists for pain management related to major abdominal and gynecologic surgeries. Our objective was to explore the potential utility of these techniques to provide anesthesia for abdominal wall procedures in the emergency department (ED). ⋯ In a series of 4 ED patients, ultrasound-guided TAP and ilioinguinal/iliohypogastric blocks performed by emergency physicians provided excellent procedural anesthesia. Further study of these techniques as an alternative to sedation for ED patients undergoing abdominal wall procedures is warranted.