Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Patients with altered level of consciousness may be suffering from elevated intracranial pressure (EICP) from a variety of causes. A rapid, portable, and noninvasive means of detecting EICP is desirable when conventional imaging methods are unavailable. ⋯ Despite small numbers and selection bias, this study suggests that bedside ED US may be useful in the diagnosis of EICP.
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Verbally administered numerical rating scales (NRSs) from 0 to 10 are often used to measure pain, but they have not been validated in the emergency department (ED) setting. The authors wished to assess the comparability of the NRS and visual analog scale (VAS) as measures of acute pain, and to identify the minimum clinically significant difference in pain that could be detected on the NRS. ⋯ The findings suggest that the verbally administered NRS can be substituted for the VAS in acute pain measurement.
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Comparative Study
Impact of critical bed status on emergency department patient flow and overcrowding.
To compare measurements of emergency department (ED) patient flow during periods of acute ED overcrowding and times of normal patient volume (NPV). ⋯ During times of acute overcrowding, the most significant delay occurs awaiting placement in the ED bed.
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To determine participant perceptions of Emergency Medicine Crisis Resource Management (EMCRM), a simulation-based crisis management course for emergency medicine. ⋯ The EMCRM participants rated the course very favorably and believed that the knowledge gained would be beneficial in their practices. The extremely positive response to EMCRM found in this pilot study suggests that this training modality may be valuable in training emergency medicine residents.
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To evaluate the prevalence of resistance of the various urinary tract infection (UTI) pathogens obtained from patients in an urban pediatric emergency department (PED), and to identify risk factors for infection with resistant strains. ⋯ The resistance to T-S in this study was 6.7% for gram-negative pathogens. These rates are lower than rates reported in adult populations, international pediatric studies, and the authors' hospital antibiograms, demonstrating the importance of local, population-specific data in selecting antibiotics. This study did not identify any statistically significant risk factors for resistance to T-S, but suggests that those with a recent history of antibiotic use may be at highest risk. While children less than 4 years old with gram-negative pathogens have nominally lower rates of T-S resistance, they are at higher risk for resistance to one or more antibiotics (any resistance) and are at risk for UTI caused by enterococcus (uniformly nonsusceptible to T-S). Prospective studies are needed to validate these results and to identify predisposing factors for urinary pathogens with antibiotic resistance.