European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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An increased lactate level is related to increased mortality in subpopulations of critically ill patients. The aim of this study was to investigate whether lactate was related to mortality in an emergency department (ED) setting of undifferentiated medical patients. All adult patients admitted from March 2009 to August 2011 to a medical ED with lactate measured within 6 h after arrival were studied. ⋯ The median lactate level was 1.2 mmol/l (5-95% percentiles 0.6-3.8 mmol/l, range 0.2-22 mmol/l). Lactate was associated with 10-day mortality independent of age, comorbidity and presence of hypotension, with an odds ratio of 1.54 (95% confidence interval 1.44-1.63) per 1 mmol/l increase. Lactate is an independent predictor of 10-day mortality among patients admitted to a medical ED.
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Review
Quality of work life, burnout, and stress in emergency department physicians: a qualitative review.
A 2006 literature review reported that emergency department (ED) physicians showed elevated burnout levels and highlighted several environment and personal issues contributing toward burnout. Research on burnout in EDs is limited. We propose an updated qualitative review on the relationships between work stress, burnout, and quality of work life in ED physicians. ⋯ ED physicians showed moderate to high levels of burnout with difficult work conditions including significant psychological demands, lack of resources, and poor support. Nonetheless, physicians reported high job satisfaction. Further studies should focus on the implementation of measures designed to prevent burnout.
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The aim of this study was to evaluate which factors are associated with early hospital arrival and help-seeking delays in acute stroke. All consecutive eligible patients were interviewed face-to-face within 72 h of admission. Factors associated with early arrival were assessed by univariate and multivariate analysis. ⋯ The most common reasons for delaying seeking help were the hope for spontaneous recovery and perceiving the elapsed time as insignificant. The patients who call their family physician lose valuable time and their chance for thrombolysis. Many patients probably neglect symptoms because of stroke itself and therefore do not act fast enough.
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Decreased general condition (DGC) is a frequent presenting complaint within the Adaptive Triage Process. DGC describes a nonspecific decline in health and well-being, and it is common among elderly patients in the emergency department (ED). ⋯ Patients presenting with DGC to an ED often receive low triage priority, frequently require admission for in-hospital care, and, because of the three-fold increased risk of in-hospital death compared with others, belong to a high-risk group.
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Letter Case Reports
Ultrasound evaluation of an atypical traumatic rupture of the tunica albuginea.