J Emerg Med
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Unenhanced computed tomography (CT) is a frequently used imaging method in patients who are evaluated in the emergency department with suspected cerebral vein thrombosis (CVT). ⋯ Hyperattenuation in the dural sinuses and the HU/Htc ratio in unenhanced brain CT scans have high diagnostic value in detecting CVT.
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Observational Study
Soluble Urokinase Plasminogen Activator Receptor as a Decision Marker for Early Discharge of Patients with COVID-19 Symptoms in the Emergency Department.
Severe acute respiratory syndrome coronavirus 2 (The Covid-19 pandemic) strains health care capacity. Better risk stratification, with discharge of patients with a predicted mild disease trajectory, can ease this burden. Elevated blood-soluble urokinase plasminogen activator receptor (suPAR) has previously been shown to be associated with risk of intubation in confirmed COVID-19 patients. ⋯ suPAR is a potential biomarker for triage and safe early discharge of patients with COVID-19 symptoms in the ED. suPAR can be used even before SARS-CoV-2 status is known.
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Observational Study
High-Dose Nitroglycerin Bolus for Sympathetic Crashing Acute Pulmonary Edema: A Prospective Observational Pilot Study.
Sympathetic crashing acute pulmonary edema (SCAPE) is a severe form of hypertensive acute heart failure with a dramatic presentation. Rapid identification and management in the emergency department (ED) is key to saving these patients and preventing morbidity associated with endotracheal intubation and intensive care treatment. Use of high-dose nitroglycerin (NTG) and noninvasive ventilation (NIV) has been advocated in management of such patients. ⋯ Use of our specific SCAPE treatment algorithm, which included high-dose NTG and NIV, was safe and provided rapid resolution of symptoms.
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Staffing and provider capacity are essential components of emergency department (ED) throughput. Patient flow is dependent on matching patient arrivals with provider capacity. Current models assume a static rate of patients per hour for providers; however, this metric has been shown to decrease throughout a shift in a pattern we describe as a staircase. ⋯ Academic EDs may find value in using a staircase model to analyze provider capacity because it is more reflective of actual capacity. EDs may benefit from visualizing their capacity curves to identify mismatches and staggering resident shifts to improve throughput and flow.
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Bag-valve-mask (BVM) ventilation using a two-handed mask-face seal has been shown to be superior to a one-handed mask-face seal during cardiopulmonary resuscitation (CPR). ⋯ With minor modifications to the conventional method of simulated two-rescuer CPR, rescuers can deliver significantly higher volumes of rescue breaths without compromising the quality of chest compressions.