J Emerg Med
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Multicenter Study Comparative Study
Volume and Acuity of Emergency Department Visits Prior To and After COVID-19.
There are scant data regarding the change in volume and acuity of patients presenting to emergency departments (EDs) after Coronavirus Disease 2019 (COVID-19), compared with the pre-COVID-19 era. ⋯ Sharp declines in ED visits and the triage acuity seen in both general and specialty hospitals raise the concern that severely ill patients may not be seeking timely care, and a surge may be expected once current restrictions on movement are lifted.
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Some experts recommend using a 1-h sepsis bundle, but clinical data supporting this strategy are lacking. ⋯ In a group of code sepsis patients from facilities that use a 1-h sepsis bundle, the majority were ultimately not diagnosed with sepsis, and nearly half did not have a bacterial infection. A small minority of patients had bacteremia. Restricting blood culture ordering in patients with possible sepsis to only those who have increased risk for bacteremia could lead to a more judicious use of blood cultures.
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Hypertrophic osteoarthropathy (HOA) is a musculoskeletal pathology that often occurs as a paraneoplastic syndrome. 90% of HOA cases occur secondary to malignancy. 60 to 80% of which are lung cancers. ⋯ We present a case of a 61-year-old man who had worsening knee pain. HOA was incidentally noted on extremity X-ray. The patient was found to have a soft-tissue attenuating mass on chest X-ray. The diagnosis of non-small cell lung cancer was made after bronchoscopy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: HOA can be an indication of malignancy, most commonly lung cancer, so it is important to recognize the key radiographic findings associated with HOA. When treating patients with bone pain and clubbed digits, emergency physicians should strongly consider screening for more severe primary pathology.
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The cause of a pediatric out-of-hospital cardiac arrest (OHCA) may go unexplained in the emergency department setting but can be secondary to a toxicologic etiology. It is unclear how toxicologic screens are used in the postarrest period after a pediatric OHCA. ⋯ Our study found that in pediatric OHCA, toxicologic screens were completed but were not routinely sent in our institution. There may be factors such as clinician bias or the severity of a patient's illness that impact the approach to toxicologic screening in pediatric OHCA. In addition to the history and physical examination, emergency physician and pediatric intensivists should consider routinely sending toxicologic screens to assist in uncovering any accidental or malicious explanation for the event.
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Emergency departments (EDs) worldwide experience substantial variability in hourly patient arrivals. The month of Ramadan represents a repetitive annual occurrence, which could be associated with distinct patient arrival patterns compared with other months of the year. ⋯ We found a drop in daily ED visits during Ramadan, in addition to a distinct pattern of patient arrivals. ED administrators should consider different scheduling arrangements for nurses and physicians during this period in EDs that serve communities where Ramadan is commonly observed.