European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Observational Study
Hyperglycemia in emergency patients - prevalence and consequences: results of the GLUCEMERGE analysis.
Hyperglycemia is a common finding in emergency department (ED) patients, but its general relevance for the further clinical course has not been determined as yet. ⋯ ED hyperglycemia was found to be a strong predictor of in-hospital outcome, whereas responding ED management was inadequate. Further prospective studies are needed to determine whether systematic ED hyperglycemia management could improve outcomes.
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The aim of this study was to identify predictors of ICU transfer or death within 48 h obtainable within 4 h of admission in emergency department (ED) patients with suspected infection. ⋯ Readily available clinical and laboratory variables at arrival in the ED can support identification of late deterioration leading to ICU transfer or death within 48 h of admission.
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High blood pressure (HBP) is observed frequently in patients with spontaneous intracerebral haemorrhage (SICH). Although HBP at admission has been associated with poor outcomes, most studies from which such conclusions were derived had been carried out decades earlier, when aggressive BP management was not implemented. In our institution, SICH patients showing HBP undergo aggressive BP management by intravenous nicardipine with target systolic BP (SBP) less than 140 mmHg. We investigated whether responsiveness to intravenous nicardipine, haematoma expansion rate and activity of daily living 90 days after admission differed by the degree of admission SBP. ⋯ The lack of difference in the demographic and outcome variables in SICH patients managed by aggressive treatment to normalize the BP indicates that the previously reported association between HBP at admission and poor outcomes needs to be re-evaluated.
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Nontechnical skills can make a difference in the management of disasters and mass casualty incidents and any tool helping providers in action might improve their ability to respond to such events. Google Glass, released by Google as a new personal communication device, could play a role in this field. We recently tested Google Glass during a full-scale exercise to perform visually guided augmented-reality Simple Triage and Rapid Treatment triage using a custom-made application and to identify casualties and collect georeferenced notes, photos, and videos to be incorporated into the debriefing. Despite some limitations (battery life and privacy concerns), Glass is a promising technology both for telemedicine applications and augmented-reality disaster response support to increase operators' performance, helping them to make better choices on the field; to optimize timings; and finally represents an excellent option to take professional education to a higher level.
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Atrial fibrillation (AF) and flutter are common tachyarrhythmias seen in the Emergency Department (ED). The management of recent-onset AF remains poorly defined. Two management strategies have been proposed: rhythm control versus rate control. The aims of this study were to investigate the epidemiology and management of recent-onset AF presenting to one large tertiary ED. ⋯ The epidemiology of recent-onset AF in this series is comparable with previous publications. Rhythm control was only attempted in approximately half of all eligible patients. There was no single-favoured management strategy. Our results mirror the literature in emphasizing the variation in management and the lack of robust evidence guiding the management of recent-onset AF and flutter.