Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The Centers for Disease Control and Prevention (CDC) recommends routine human immunodeficiency virus (HIV) screening of emergency department (ED) patients aged 13 to 64 years. The study objectives were to determine the accessibility of rapid HIV testing in academic EDs, to identify factors that influence an ED's adoption of testing, and to describe current HIV testing practices. ⋯ Most academic EDs now offer rapid HIV testing (57%), but few use it in situations other than occupational exposure. Less than half of academic EDs expect to implement CDC guidelines regarding routine screening within the next few years. The authors identified facility characteristics (e.g., counseling, ability to refer) that may influence adoption of rapid HIV testing.
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Measurements of the optic nerve sheath diameter (ONSD) using bedside ultrasound (US) have been shown to correlate with clinical and radiologic signs and symptoms of increased intracranial pressure (ICP). ⋯ Using an ROC curve the authors systematically confirmed the commonly used threshold of ONSD > 5 mm to detect ICP > 20 cm H2O. This study directly correlates ventriculostomy measurements of ICP with US ONSD measurements and provides further support for the use of ONSD measurements as a noninvasive test for elevated ICP.
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Comparative Study
Comparison of pediatric emergency physicians' and surgeons' evaluation and diagnosis of appendicitis.
To compare the interexaminer reliability and ability to predict appendicitis between pediatric emergency physicians (EPs) and senior surgical residents. ⋯ Pediatric EPs and senior surgical residents elicit historical findings from patients with suspected appendicitis with a greater degree of similarity than physical examination findings, which exhibit a wide degree of variability. Pediatric EPs and senior surgical residents do not differ in their ability to clinically predict appendicitis. These findings may be helpful in developing institutional management protocols.
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Comparative Study
Comparison of 15:1, 15:2, and 30:2 compression-to-ventilation ratios for cardiopulmonary resuscitation in a canine model of a simulated, witnessed cardiac arrest.
This experimental study compared the effect of compression-to-ventilation (CV) ratios of 15:1, 15:2, and 30:2 on hemodynamics and resuscitation outcome in a canine model of a simulated, witnessed ventricular fibrillation (VF) cardiac arrest. ⋯ In a canine model of witnessed VF using a simulated scenario, CPR with three CV ratios, 15:1, 15:2, and 30:2, did not result in any differences in hemodynamics, arterial oxygen profiles, and resuscitation outcome among the three groups. CPR with a CV ratio of 15:1 provided comparable chest compressions and shorter pauses for ventilation between each cycle compared to a CV ratio of 30:2.
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Multicenter Study
Prospective multicenter study of the viral etiology of bronchiolitis in the emergency department.
To determine the viral etiology of bronchiolitis and clinical characteristics of children age < 2 years presenting to the emergency department (ED) with bronchiolitis. ⋯ In this multicenter study, RSV was the most frequent cause of bronchiolitis (64%). RV was present in 16%, and these children have a distinct profile in terms of demographics, medical history, and ED treatment.