J Emerg Med
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Review Case Reports
Acute Lobar Nephronia: A Case Report and Literature Review.
Patients with fever, vomiting, and abdominal pain commonly present to the emergency department, often generating a broad differential diagnosis. We describe the first reported case in the emergency medicine literature of acute lobar nephronia (ALN). ⋯ A normal urinalysis may move clinicians to dismiss a nephrogenic or urologic process. ALN is considered a midpoint in the spectrum of upper urinary tract infections between acute pyelonephritis and intrarenal abscess. Diagnosis may be difficult, and inpatient management, sometimes prolonged, is the norm.
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Randomized Controlled Trial
The Most Effective Rescuer's Position for Cardiopulmonary Resuscitation Provided to Patients on Beds: A Randomized, Controlled, Crossover Mannequin Study.
The effectiveness of chest compressions for cardiopulmonary resuscitation (CPR) is affected by the rescuer's position with respect to the patient. In hospitals, chest compressions are typically performed while standing beside the patient, who is placed on a bed. ⋯ The mean compression depth and the number of adequate compressions were greater for both the kneeling and footstool positions than for the standing position during 2 min of CPR. We recommend kneeling on a bed or standing on a footstool as the rescuer positions during hospital CPR on a bed.
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Childhood trauma is an important public health problem with financial, physical health, and mental health repercussions. Emergency departments (EDs) are often the first point of contact for many young children affected by emotionally or psychologically traumatic events (e.g., neglect, separation from primary caregiver, maltreatment, witness to domestic violence within the family, natural disasters). ⋯ Preventing recurrent trauma or recognizing early trauma exposure is difficult, but essential if long-term negative consequences are to be mitigated or prevented. Within EDs, there are missed opportunities for identification and intervention for trauma-exposed children, as well as great potential for expanding primary and secondary prevention of maltreatment-associated illness, injury, and mortality.
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Tubular gauze dressings are commonly used, but have potential to cause iatrogenic finger ischemia. ⋯ It is important that circumferential digital dressings are applied correctly. Vascular insufficiency from an occlusive dressing is an iatrogenic and avoidable complication. Successful operative decompression may be indicated to minimize tissue loss and improve circulation.
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Emergency department (ED) overcrowding with boarders and waiting times are a significant concern in many countries. ⋯ Boarding patients in the ED has a negative effect on compliance with our 6-h standard of time to disposition.