European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The aim of the present study was to evaluate the presence and degree of spontaneous echo contrast (SEC) in the left atrium and of left atrial appendage (LAA) contractility before and after cardioversion (CV) in patients with recent-onset atrial fibrillation (AF). ⋯ The absence of thrombogenic milieu and of left atrial stunning after CV in patients with recent-onset AF favours early CV without anticoagulation, at least in patients with a low thromboembolic risk profile. These patients could be discharged earlier from urgent care.
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Techniques for extricating vehicle occupants after road-traffic collisions have evolved largely through fear of worsening a cervical spine injury, rather than being evidence-based. Recent research has looked at the safety of allowing the alert patient to self-extricate, rather than being assisted with equipment such as long spinal boards and semirigid cervical collars. This review aims to elucidate whether it is safe to allow an alert, ambulant patient to self-extricate from a vehicle with minimal or no cervical spine immobilization. ⋯ Furthermore, an alert patient with a neck injury will demonstrate a self-protection mechanism, ensuring injuries are not worsened. Evidence is now building that self-extrication in alert patients with minimal or no cervical spine immobilization is safe. Self-extrication should become more commonplace, conferring not only a potential safety benefit but also advantages in time to definitive care and resource use.
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Multicenter Study Observational Study
GYM score: 30-day mortality predictive model in elderly patients attended in the emergency department with infection.
To determine the validity of the classic sepsis criteria or systemic inflammatory response syndrome (heart rate, respiratory rate, temperature, and leukocyte count) and the modified sepsis criteria (systemic inflammatory response syndrome criteria plus glycemia and altered mental status), and the validity of each of these variables individually to predict 30-day mortality, as well as develop a predictive model of 30-day mortality in elderly patients attended for infection in emergency departments (ED). ⋯ The GYM score showed better capacity than the classic and the modified sepsis criteria to predict 30-day mortality in elderly patients attended for infection in the ED.
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In small studies, Screening, Brief Intervention and Referral to Treatment (SBIRT) in Emergency Departments (EDs) is effective in reducing hazardous alcohol use. ⋯ Our study shows that in a large inner-city ED, SBIRT can be implemented in daily care. Screening uncovered large numbers of patients with hazardous alcohol use and identified several risk factors. Moreover, screening and intervention appeared to be effective in reducing alcohol intake.