Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Comparative Study
The association between emergency department crowding and adverse cardiovascular outcomes in patients with chest pain.
While emergency department (ED) crowding is a worldwide problem, few studies have demonstrated associations between crowding and outcomes. The authors examined whether ED crowding was associated with adverse cardiovascular outcomes in patients with chest pain syndromes (chest pain or related complaints of possible cardiac origin). ⋯ There was an association between some measures of ED crowding and a higher risk of adverse cardiovascular outcomes in patients with both ACS-related and non-ACS-related chest pain syndrome.
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Overlap of the femoral artery (FA) on the femoral vein (FV) has been shown to occur in pediatric patients. This overlap may increase complications such as arterial puncture and failed insertions of central venous lines (CVLs). Knowledge of the anatomic relationship between the FV and FA may be important in avoiding these complications. ⋯ A significant percentage of children have FAs that overlap their FVs. This overlap may be responsible for complications such as FA puncture with CVL placement. Ultrasound-guided techniques may decrease these risks. Placing children in the frog leg position increases the diameter of the FV visualized on ultrasound.
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The authors assessed the effect of emergency department (ED) crowding on the nontreatment and delay in treatment for analgesia in patients who had acute abdominal pain. ⋯ Emergency department crowding is associated with delays in analgesic treatment from the time of triage in patients presenting with acute abdominal pain.
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Clinical scoring systems attempt to improve the diagnostic accuracy of pediatric appendicitis. The Pediatric Appendicitis Score (PAS) was the first score created specifically for children and showed excellent performance in the derivation study when administered by pediatric surgeons. The objective was to validate the score in a nonreferred population by emergency physicians (EPs). ⋯ The PAS is a useful tool in the evaluation of children with possible appendicitis. Scores of
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The objective was to identify the epidemiology of serious bacterial infections (SBI) and the current utility of obtaining routine complete blood counts (CBC) and blood cultures to stratify infants at risk of SBI, in the study population of febrile infants in the post-heptavalent pneumococcal conjugate vaccine (PCV7) era. ⋯ The WBC count and height of fever were not found to be accurate predictors of SBI in infants age 3 to 24 months. UTI and pneumonias made up the vast majority of SBI in this population of infants. The overall bacteremia frequency was well below 1%. This calls into question the continued utility of obtaining routine complete cell counts and blood cultures in the febrile infant in the post-PCV7 era.