Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The objective was to evaluate the effect of arrival to the emergency department (ED) by emergency medical services (EMS) on time to initiation of antibiotics, time to initiation of intravenous fluids (IVF), and in-hospital mortality in patients with severe sepsis and septic shock. ⋯ Out-of-hospital care was associated with improved in-hospital processes for the care of critically ill patients. Despite shortened ED treatment times for septic patients who arrive by EMS, a mortality benefit could not be demonstrated.
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Despite increasing attention to the long-term risks of radiation exposure and contrast-induced nephropathy (CIN), institutional guidelines and patient consent procedures for contrast-enhanced computed tomography (CECT) imaging in the emergency department (ED) setting have focused primarily on more immediate complications, directly attributable to the administration of intravenous (IV) iodinated contrast administration. Thus, this study sought to define the risk of these immediate complications with the overall aim of improving institutional guidelines and patient consent procedures. ⋯ The frequency of severe, immediate complications from CECT imaging that includes IV contrast is less than 1%, and the frequency of mild complications is less than 2%. The authors conclude that CECT is associated with a very low rate of severe immediate complications.
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The objective was to determine if geospatial techniques can be used to inform targeted community consultation (CC) and public disclosure (PD) for a clinical trial requiring emergency exception from informed consent (EFIC). ⋯ Geospatial techniques and hospital data records can be used to characterize potential subjects and delineate a high-risk population to inform directed CC and public disclosure strategies.
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Due to the rapid growth in academic emergency departments over the past 20 years, recent significant changes in leadership have occurred. To prepare for future transitions, leaders in academic emergency medicine (EM) should identify those skills and characteristics desired in future academic chairs. The authors sought to determine which skills and characteristics are more important than others to help guide the development of EM-specific leadership courses. ⋯ Leadership courses for aspiring chairs in EM should foster the development of academic experience and managerial skills. Advanced degrees in leadership or administration are highly desirable in future chairs.
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The objective was to describe patient and facility characteristics of emergency department (ED) observation services in the United States. ⋯ Over one-third of U.S. EDs have an OU. Short-stay admission patients have similar characteristics as ED observation patients and may represent an opportunity for the growth of OUs.