J Emerg Med
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Review
Toward Reduction of Post-Hospital Admission Death Rate Caused by Acute Traumatic Aortic Tear.
Terminology and classifications are the vehicles by which pathologic conditions are identified and understood. It is critically important for the patient admitted with suspected blunt thoracic aortic injury that admitting physicians have a thorough knowledge of acute traumatic aortic tear and its natural history. ⋯ Reduction of post-hospital death caused by acute aortic tear requires knowledge and understanding of the pathology of acute traumatic aortic tear and its natural history. Such understanding of pathology of acute traumatic aortic tear and its natural history is enhanced by terminology that defines the aortic injury. Therefore, we present our proposed terminology and classification of acute traumatic injuries.
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Transfusion of red blood cells (RBCs) is the primary management of anemia, which affects 90% of critically ill patients. Anemia has been associated with a poor prognosis in various settings, including critical illness. Recent literature has shown a hemoglobin transfusion threshold of 7 g/dL to be safe. This review examines several aspects of transfusion. ⋯ RBC transfusion is not without risks, including transfusion reaction, infection, and potentially increased mortality. The age of transfusion products likely has no effect on products before 21 days of storage. A hemoglobin level of 7 g/dL is safe in the setting of critical illness, sepsis, gastrointestinal bleeding, and trauma. The clinician must evaluate and transfuse based on the clinical setting and patient hemodynamic status rather than using a specific threshold.
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Observational Study
The Effect of Antiemetics and Antihistamines on the QTc Interval in Emergent Dialysis Patients With Baseline QTc Prolongation.
Unfunded patients with end-stage renal disease (ESRD) who do not have routinely scheduled hemodialysis often receive medications known to prolong the QTc interval for their uremic symptoms even though they may have pre-existing QTc prolongation. ⋯ This study shows that medications known to cause QTc prolongation are safe to use in therapeutic doses in patients with ESRD who have pre-existing QT prolongation. Few patients in this cohort had significantly prolonged QTc intervals at baseline.
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Observational Study
A Pilot Trial to Increase Hospice Enrollment in an Inner City, Academic Emergency Department.
Hospice is underutilized, with over 25% of enrolled patients receiving hospice care for 3 days or less. The inner city emergency department (ED) is a highly trafficked area for patients in the last 6 months of life, and is a potential location for identification of hospice-eligible patients and early palliative care (PC) intervention. ⋯ Our pilot study presents a unique approach to early identification and disposition of hospice-appropriate patients, and suggests EPs may have sufficient prognostic accuracy to perform this task.