J Emerg Med
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Patients suffering ST segment elevation myocardial infarction (STEMI) requiring transfer from a non-percutaneous coronary intervention (PCI) hospital to a PCI-capable hospital often have prolonged treatment times. ⋯ We document a significantly reduced DIDO and FMC2b time after changing mode of transportation for STEMI patients transferred 30 miles for primary PCI. Utilizing ground rather than air transportation, the median FMC2b time was reduced from 123 to 90 min. We show that mode of transportation can dramatically reduce both DIDO time and FMC2b time.
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Review Case Reports
Head and Neck Myiasis, Cutaneous Malignancy, and Infection: A Case Series and Review of the Literature.
There is a paucity of literature on wound myiasis of the head and neck originating in the United States. To our knowledge, only three reports during the past 20 years exist in the literature. Even less common is a case of recurrent myiasis, with only one report published from India during the 1970s. There is often a preconceived notion that larvae are noninvasive and "only eat dead tissue." This mentality must be corrected; invasive larvae exist, there are unique myiasis-related infections, and serious complications can occur. We review the literature and describe recent cases of head and neck myiasis treated at our institution in upstate New York. ⋯ Four cases, all initially presenting to the emergency department, were identified. Each case was superimposed on cutaneous malignancy and all patients presented with leukocytosis and positive blood or wound cultures. In the case of the recurrent myiasis, initial treatment was external beam radiation therapy for the malignancy, which had the added benefit of eradicating the larvae. Treatment for the other cases was limited to antibiotics and supportive care for medical comorbidities. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Serious complications can develop from head and neck myiasis and, in our experience, an underlying malignancy should be suspected. Proper management is critical and should include, at a minimum, empiric antibiotics, tetanus prophylaxis, biopsy of the surrounding tissue, and reporting to the appropriate health agency. Additional management can include bedside debridement, pharmacologic antiparasitics, and treatment of the underlying disorder.
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Observational Study
Hemodynamic Effects of Nitroglycerin Ointment in Emergency Department Patients.
Nitroglycerin ointment is commonly used in the treatment of emergency department (ED) patients with suspected acute heart failure (AHF) or suspected acute coronary syndrome (ACS), but its hemodynamic effects in this population are not well described. ⋯ Among ED patients who are treated with nitroglycerin ointment, MAP and TFC decrease over time. However, other hemodynamic parameters do not change after application of nitroglycerin ointment in these patients.
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Hand sanitizing, although often a "forgotten" practice, has been demonstrated to be a leading factor in preventing infectious disease transmission in health care environments. Previous studies have looked at hand-sanitization rates in hospital settings, but we are aware of very few describing this in the prehospital setting. Because emergency medical services (EMS) providers are potential vectors of infectious disease spread, it is important to know if their hand-sanitization practices are sufficient. ⋯ Hand-sanitization events were noted in this convenience sample group a majority of times in association with patient contact. However, there appears to be substantial room for improvement. This suggests that EMS services should work to improve hand-sanitization compliance. Increased instruction, education, or access to hygiene equipment should be investigated as avenues to improve future compliance.
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Frequent and unnecessary utilization of the emergency department (ED) is often a sign of serious latent patient issues, and the associated costs are shared by many. Helping these patients get the care they need in the appropriate setting is difficult given their complexity, and their tendency to visit multiple EDs. ⋯ When examined as a whole, research on the program suggests that expanding it would be an efficient allocation of hospital, and possibly societal, resources.