Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Editorial Comment
Repeat visits by elder emergency department patients: sentinel events.
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Randomized Controlled Trial Clinical Trial
Frequent users of the emergency department: can we intervene?
To determine whether the use of individualized patient care plans and multidisciplinary case management would decrease ED utilization by frequent ED users. ⋯ The use of individualized care plans and case management did not significantly decrease ED utilization by frequent ED users. However, the impact of individualized care plans and case management on other quality-of-care measures (e.g., patient satisfaction, ED length of stay, hospitalizations, primary care visits, and health care costs) remains to be determined.
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To investigate how often the ED ordering of stat serum calcium (Ca+2), magnesium (Mg+2), and phosphorus (PO4(-3)) levels affected clinical treatment; to define the diagnoses of patients for whom Ca+2, Mg+2, and PO4(-3) measurements did affect clinical therapy; and to suggest guidelines for more appropriate ordering of these laboratory tests. ⋯ These results suggest that stat Ca+2, Mg+2, and PO4(-3) levels seldom affect clinical treatment in the ED. The frequency of ordering these tests may be reduced by obtaining Ca+2, Mg+2, or PO4(-3) measurements only for patients known to be at risk for such abnormalities, based on their existing or suspected diagnoses. The authors suggest obtaining these tests, when indicated, on a "non-stat" basis, with the subsequent laboratory results becoming available in-hospital, where treatment is more likely to occur.
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To identify characteristics associated with provision of bystander CPR in witnessed out-of-hospital cardiac arrest cases. ⋯ Patients who have had witnessed cardiac arrests outside the home are nearly 4 times more likely to receive bystander CPR, and are twice as likely to survive. This observation emphasizes the need for CPR training of family members in the authors' locale. This phenomenon may also represent a significant confounder in studies of out-of-hospital cardiac arrest and resuscitation.
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Case Reports
Bioimpedance cardiac output measurements in patients with presumed congestive heart failure.
To describe preliminary ED experience with thoracic electrical bioimpedance (TEB) for evaluation of patients with complaints suggestive of congestive heart failure (CHF). ⋯ Significant differences in TEB variables exist between patients who appear similar on initial examination in the ED. Changes noted on TEB may help to further elucidate physiologic differences. The clinical use of TEB-based hemodynamic measurements to guide presumed CHF patient management remains speculative.