The American journal of emergency medicine
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The prognostic significance of conversion into a shockable rhythm in patients who experienced out-of-hospital cardiac arrest (OHCA) with an initially nonshockable rhythm is controversial, perhaps due to the timing of rhythm conversion not being considered previously. We aimed to compare the different prognoses of patients with OHCA and early and late conversion of their rhythm into a shockable rhythm. ⋯ In patients who experience OHCA and have an initially nonshockable rhythm, early conversion into a shockable rhythm resulted in a better prognosis, whereas late conversion was not significantly different from nonconversion.
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We sought to assess if a state-wide lockdown implemented due to COVID-19 was associated with increased odds of being a potentially avoidable transfer (PAT). ⋯ We did not find an effect of the COVID-19 lockdown on PATs though there was a considerable seasonal effect and an overall downward trend in PATs over time.
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Hospital-based emergency departments have been a sustained source of overall hospital utilization in the United States. In 2019, an estimated 150 million hospital-based emergency department (ED) visits occurred in the United States, up from 90 million in 1993, 108 million in 2000 and 137 million in 2015. This study analyzes hospital ED visit registration data pre and post to the COVID-19 pandemic describe the impact of on hospital ED utilization and to assess long-term implications of COVID and other factors on the utilization of hospital-based emergency services. ⋯ There is a wide range of potential long-term implications of the observed reduction in the demand for hospital-based emergency services not only for emergency physicians, but for hospitals, health plans and consumers.
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Skin and soft tissue infections account for 2% of emergency department visits annually, though more unusual causative bacteria associated with saltwater exposure may result in morbidity. Mycobacterium marinum represents a rare but important cause of cellulitis, which if untreated or improperly managed, can progress to dactylitis or osteomyelitis. ⋯ While doxycycline is one antibiotic providing saltwater coverage, M. marinum has variable sensitivities to anti-mycobacterial antibiotics, and thus biopsy helps confirm the diagnosis as well as provide sensitivities for treatment. Emergency clinicians should inquire about environmental risk factors when caring for patients with cellulitis, especially with atypical skin presentations, and consider M. marinum as a rare but important cellulitis etiology.