The American journal of emergency medicine
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Multicenter Study
The effects of the 2022 computed tomography IV contrast shortage on the emergency department diagnosis of abdominal pathology.
A COVID-19 lockdown in China resulted in a global disruption in IV contrast media production, which resulted in a hospital system advisory limiting contrast studies. The purpose of this study was to describe the effects of the IV contrast shortage on the ED diagnosis of emergent abdominopelvic pathology. ⋯ We did not identify differences in diagnoses during the contrast shortage period compared to the control period, and did not identify any missed important diagnoses as a consequence of the IV contrast shortage.
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Multicenter Study
Characteristics of patients enrolled in hospice presenting to the emergency department.
Emergency Departments (EDs) frequently care for patients with life-limiting illnesses, with nearly 1 in 5 patients enrolled in hospice presenting to an ED during their hospice enrollment. This study investigates the reasons patients enrolled in hospice seek care in the ED, the interventions they receive, and their outcomes. ⋯ Patients enrolled in hospice most frequently presented to the ED for trauma. Most received laboratory studies and imaging. Nearly half of patients were admitted to the hospital and short-term mortality was high, particularly for patients enrolled in hospice for <30 days, enrolled with a hospice diagnosis of cancer, or admitted to the hospital. Understanding the care patients enrolled in hospice receive in the ED can help prevent avoidable visits and ensure care aligns with patients' goals.
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Comparative Study
Assessing the evolution of pre-hospital combat casualty care: A comparative study of two conflicts a decade apart.
Combat casualty care has advanced significantly with the implementation of evidence-based protocols designed to lower combat-related mortality. Over the last decade, two major urban conflicts in southern Israel have challenged the evolving military trauma system. This study aimed to assess differences in prehospital care and compare the outcomes of aeromedically evacuated casualties from the 2014 and 2023 conflicts. ⋯ Over the past decade, there has been a decline in prehospital airway interventions and thoracostomies, coupled with an increase in early blood transfusions. Despite greater injury severity, mortality rates have remained stable. Although not statistically significant, lower mortality rates were recorded among the severely and critically injured. These findings support the "less is more" approach in modern prehospital combat casualty care.
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Blood donation is a life-saving process that involves the temporary loss of a specific blood volume. Although generally safe, it may lead to adverse reactions, particularly in first-time donors. Among these, severe outcomes like myocardial infarction (MI) are extremely rare. ⋯ Acute volume loss and sudden intravascular hemoglobin changes were likely contributing factors in this case. Although rare, the association between blood donation and MINOCA highlights the need for vigilance in donors with acute symptoms. Blood donors presenting with dizziness or hypotension should be evaluated comprehensively.
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Crystalloid administration during early resuscitation of bleeding trauma patients is recommended by current guidelines, yet evidence supporting this practice is limited. We aimed to evaluate the trends in the utilization of crystalloids during the last decade and to determine the threshold crystalloid volume independently associated with mortality risk in trauma patients at risk of or experiencing shock. ⋯ The administration of ≥2 liters of crystalloids during the initial phase of care was independently associated with increased mortality in hemodynamically compromised trauma patients. These findings support the judicious and goal-directed use of crystalloids in the resuscitation of trauma patients.