Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
A massive nerve agent attack may rapidly deplete in-date supplies of atropine. The authors considered using atropine beyond its labeled shelf life. The objective was to determine the stability of premixed injectable atropine sulfate samples with different expiration dates. ⋯ Significant amounts of atropine were found in all study samples. All samples remained clear and colorless, and no substantial amount of tropine was found in any study sample. Further testing is needed to determine clinical effect.
-
Comparative Study
Therapeutic yield and outcomes of a community teaching hospital code stroke protocol.
To describe the experience of a community teaching hospital emergency department (ED) Code Stroke Protocol (CSP) for identifying acute ischemic stroke (AIS) patients and treating them with tissue plasminogen activator (tPA) and to compare outcome measures with those achieved in the National Institute of Neurological Disorders and Stroke (NINDS) trial. ⋯ Over the study period, the CSP yielded approximately one IV tPA-treated patient for every four screened and, despite prevalent protocol violations, attained three-month functional outcomes equal to those achieved in the NINDS trial. For community teaching hospitals, ED-directed CSPs are a feasible and effective means to screen AIS patients for treatment with thrombolysis.
-
To assess serum procalcitonin (PCT) and white blood cell (WBC) count in detecting bacteremia in elder emergency department (ED) patients. ⋯ In elder ED patients, a PCT level of 0.2 ng/mL is sensitive for bacteremia and, based on its negative likelihood ratio, is moderately helpful in ruling out the diagnosis. WBC count with or without left shift performed poorly in the diagnosis of bacteremia.
-
Comparative Study
Bispectral electroencephalographic analysis of head-injured patients in the emergency department.
Bispectral analysis of single-lead electroencephalographs (BIS) has proven valuable in assessing the level of awareness in sedated patients. In this study, the authors sought to determine if BIS values had a predictive value in patients with traumatic brain injuries (TBIs). Therefore, the objective was to determine in emergency department (ED) patients presenting with head trauma whether BIS and Glasgow Coma Scale score (GCS) prior to sedation would be sensitive and specific in predicting TBI. ⋯ BIS scores obtained prior to sedative medicines in the face of trauma are predictive of TBI and neurologic outcome at discharge.
-
Bronchiolitis is the most common disease of the lower respiratory tract in the first year of life. Treatment is controversial, with studies giving conflicting views on the benefits of bronchodilators and steroids. The objectives of this study were 1) to characterize the management of bronchiolitis in pediatric emergency departments (PEDs) in Canada, 2) to determine patient outcomes following emergency department (ED) visits, and 3) to provide descriptive data regarding bronchiolitis symptoms and family/personal medical history of these patients. ⋯ This study prospectively describes the treatment of bronchiolitis in the pediatric ED. The findings are consistent with the literature regarding the reported use of bronchodilators; however, use of steroids was found to be much lower than reported in other studies. Bronchodilator use in the ED and at discharge varied significantly by site. The results capture variation in treatment practices in Canadian PEDs, which may be the result of discordant randomized controlled trial evidence. Further research is needed to establish best practices.