J Emerg Med
-
Patients' satisfaction is a common parameter tracked by health care systems and Emergency Departments (EDs). ⋯ This retrospective study demonstrated a strong association between post-visit patient call back and LR. Further prospective study with control for co-variables is warranted.
-
Case Reports
An unusual case of hypotension after fibrinolysis resulting from mediastinal hemorrhage.
Although bleeding complications may occur after fibrinolysis, mediastinal hemorrhage is extremely rare. ⋯ As fibrinolysis remains a common means of establishing reperfusion in patients with acute MI, emergency physicians should be aware of such unusual complications secondary to fibrinolysis. An orderly clinical approach with an individualized management protocol is essential in such situations so that undue instrumentation and invasive procedures with their attendant risks in a thrombolysed patient are avoided.
-
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon but serious hypersensitivity drug reaction most frequently associated with antiepileptics. Clinical manifestations include rash, fever, and visceral organ involvement, most commonly hepatitis. The mortality rate associated with DRESS syndrome is approximately 10%, the majority due to fulminant liver failure. ⋯ Given the significant mortality related to DRESS syndrome, ED staff should have a low threshold for suspecting the condition in patients who present with unusual complaints and skin findings after starting any antiepileptic drug. Early diagnosis and prompt treatment with corticosteroids is imperative.
-
It has been estimated that up to one-quarter of spinal cord injuries may be significantly worsened during extrication or early treatment after a motor vehicle accident. ⋯ In this study, no decrease in neck movement occurred for certain extrication events that included protection and assistance by the paramedics. Future work should further investigate this finding.
-
The use of multidisciplinary algorithmic pathways is one strategy to improve efficiency and quality of care in Emergency Departments (EDs). To this end, in the fall of 2005, we implemented algorithmic pathways for evaluation of ED patients with common gynecologic complaints. ⋯ Algorithmic pathways had a positive impact on patient care as measured by the average amount of time our patients spent in the ED. Gynecologic care in the ED was standardized, and length of stay for patients with gynecologic complaints decreased. The implementation of algorithms resulted in more consistent care with earlier initiation of pertinent studies, while facilitating more rapid critical decision-making by providers from both departments. Further analysis is required to examine cost-effectiveness as well as patient safety and provider satisfaction issues.