J Emerg Med
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Randomized Controlled Trial Multicenter Study
A Randomized Controlled Trial to Reduce Prehospital Delay Time in Patients With Acute Coronary Syndrome (ACS).
The literature suggests that people delay too long prior to attending emergency departments with acute coronary syndrome (ACS) symptoms. This delay is referred to as prehospital delay. Patient decision delay contributes most significantly to prehospital delay. ⋯ It is possible to reduce prehospital delay time in ACS, but the need for renewed emphasis on ambulance use is important.
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Randomized Controlled Trial Multicenter Study
Slow-onset and Fast-onset Symptom Presentations In Acute Coronary Sundrome (ACS): New Perspectives on Prehospital Delay in Patients with ACS.
Patient decision delay is the main reason why many patients fail to receive timely medical intervention for symptoms of acute coronary syndrome (ACS). ⋯ Slow-onset ACS and fast-onset ACS presentations are associated with distinct behavioral patterns that significantly influence prehospital time frames. As such, slow-onset ACS and fast-onset ACS are legitimate ACS presentation phenomena that should be seriously considered when examining the factors associated with prehospital delay.
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Randomized Controlled Trial
Management of Benign Paroxysmal Positional Vertigo: A Randomized Controlled Trial.
Benign paroxysmal positional vertigo (BPPV) is a common presenting problem. ⋯ This pilot study shows promise, and would suggest that there is no difference in symptomatic resolution, ED length of stay, or patient satisfaction between standard medical care and canalith repositioning maneuver. Physicians should consider the canalith repositioning maneuver as a treatment option.
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Emergency department (ED) crowding correlates with patient safety. Difficulties quantifying crowding and providing solutions were highlighted in the recent Institute of Medicine (IOM) report calling for the application of advanced industrial engineering (IE) research techniques to evaluate ED crowding. ED personnel workload is a related concept, with potential reciprocal effects between the two. Collaboration between emergency medicine and IE is needed to address crowding and ED personnel workload. ⋯ IE techniques provide solutions to the ED crowding problem and improve ED workload. We propose a technique novel to medicine: "Entropy," derived from information theory, which may provide insight into ED personnel workload, its potential for measuring ED crowding, and possibly, in predicting an overwhelming situation.
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Comparative Study Observational Study
Ultrasound-Guidance Can Reduce Adverse Events During Femoral Central Venous Cannulation.
Ultrasound-guidance for internal jugular central venous cannulation (CVC) has become the recommended best practice and has been shown to improve placement success and reduce complications. There is a dearth of studies that evaluate emergency point-of-care ultrasound guidance of femoral CVC. ⋯ Our experience shows that ultrasound guidance for femoral CVC might decrease complications and improve placement success, although we cannot recommend this approach without additional data. We recommend a larger study to further evaluate this technique.