Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study
Preliminary investigation of the Panic Screening Score for emergency department patients with unexplained chest pain.
The objective was to demonstrate the derivation and the preliminary validation of a brief screening score to improve recognition of panic-like anxiety in emergency department (ED) patients with unexplained chest pain. ⋯ The PSS may be useful to identify patients with unexplained chest pain who could benefit from referral to mental health professionals or their primary care providers for evaluation of panic attack and panic disorder. Prospective studies to improve and validate the PSS, followed by impact analysis, are mandatory before clinical implementation.
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Comparative Study
Effect of two different FDA-approved D-dimer assays on resource utilization in the emergency department.
The D-dimer assay has been shown to be an appropriate test to rule out pulmonary embolism (PE) in low-risk patients in the emergency department (ED). Multiple assays now are approved to measure D-dimer levels. Studies have shown a newer assay, Tina-quant, to have similar diagnostic accuracy to the VIDAS assay. ⋯ Switching D-dimer assays reduced both LOS and number of imaging studies in our patient population.
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The Emergency Severity Index (ESI) is a prospectively validated, five-level emergency department (ED) triage system designed to match triage acuity to both patient acuity and appropriate resource allocation. The study hypothesis was that, in practice, there exists an inappropriate bias toward triaging patients with abdominal pain to a higher ESI level based solely upon their mode of arrival to the ED. ⋯ After adjusting for covariates, EMS patients with abdominal pain were more likely to be triaged to a higher acuity level. Triage level was not associated with admission, but patients arriving by EMS were more likely to be admitted. This may indicate that the effect of EMS arrival on triage level assignment is actually appropriate. Further research is necessary to validate whether mode of arrival should be incorporated in the initial ESI triage acuity assignment.
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The objective was to evaluate the effectiveness, recovery time, and adverse event profile of intravenous (IV) mixed 1:1 ketamine-propofol (ketofol) for adult procedural sedation and analgesia (PSA) in the emergency department (ED). ⋯ Ketofol is an effective PSA agent in adult ED patients. Recovery times are short and adverse events are few. Patients and ED staff were highly satisfied.
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There is a growing awareness of the effects of patient death on physician well-being, and the importance of cultural and educational changes to improve coping mechanisms. The objective of this study was to explore both the effects of patient death on academic emergency physicians (EPs) and the coping mechanisms they use to deal with these events. ⋯ Patient death was reported to lead to both physical and emotional symptoms in academic EPs. Postdeath debriefing appears to happen infrequently in teaching settings, and most respondents reported that they themselves received limited training in coping with patient death. Further study is needed to both identify coping mechanisms that are feasible and effective in emergency department settings and develop teaching strategies to incorporate this information into EM residency training.