J Emerg Med
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There is limited information on the extent and clinical importance of the delay in hospital presentation of acute pulmonary thromboembolism (PTE). ⋯ Our study showed that a significant portion of patients with acute PTE had delayed presentation. Also, patients with delayed presentation had worse echocardiographic findings and higher in-hospital mortality.
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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.
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Recently, high-dose insulin (HDI) and intravenous lipid emulsion (ILE) have emerged as treatment options for severe toxicity from calcium-channel blocker (CCB) and beta blocker (BB). ⋯ HDI effectively reverses CS induced by CCBs and BBs due to its inotropic effects, uptake of glucose into cardiac muscle, and peripheral vasodilatation. ILE is theorized to sequester agents dependent on lipid solubility from the plasma, preventing further toxicity. To our knowledge, these are the first two successful cases reported using the combination of HDI and ILE for reversing CS induced by intentional ingestions of CCBs and BBs.
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Case Reports
Intragastric Balloon in the Emergency Department: An Unusual Cause of Gastric Outlet Obstruction.
Obesity has become a worldwide epidemic and is associated with significant morbidity and mortality. Many strategies to promote weight loss, including medications and surgical techniques, have been developed; however, few have proven effective. As the rates of obesity and associated complications continue to climb, there is growing pressure on the medical community to develop less invasive procedures that can provide lasting weight loss results. ⋯ With an increasingly mobile and obese global population, emergency physicians should be aware of weight loss procedures such as the IGB and appropriate time-sensitive management of high-risk complications.
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Patient satisfaction is a common parameter tracked by health care systems, and likely influences patient provider choice and may impact insurer payment. Achieving high satisfaction in an academic emergency department (ED) can be a daunting task due to variable volumes, acuity, and overcrowding. ⋯ In the study institution, patients that are called back are much more likely to have a favorable impression of the visit as assessed by likelihood to recommend regardless of WT, LOS, or TC. These data support "call back" as an effective strategy to improve ED patient satisfaction.