Emergency medicine journal : EMJ
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Abscesses are a common reason for ED visits. While many are drained in the ED, some require drainage in the operating room (OR). We observed that a higher percentage of patients at our institution in Columbus, Ohio, were admitted to the hospital with abscesses for incision and drainage (I&D) in the OR than other institutions, including paediatric institutions. Our aim was to decrease hospitalisations for abscess management. ⋯ We decreased hospitalisations for abscess I&D by using quality improvement methodology. The most influential intervention was an initiative to increase I&Ds performed in the ED. Additional interventions included expanded training of PTs, implementation of a clinical pathway, updating the EMR, improving interdepartmental communication and increasing sedation providers.
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To determine the relative importance members of the US public place on different patient attributes in triage decisions about who should receive the last available intensive care unit (ICU) bed. ⋯ Respondents favoured giving the last ICU bed available to the patient with the highest probability of surviving COVID-19. Public opinion suggests a simple guideline for physician choices based on likelihood of survival as opposed to the number of life-years saved. There was heterogeneity among respondents of different age groups for allocating the last ICU bed, as well as to the importance of the patient having an Alzheimer's-like disability (where religion of the respondent is important) and the gender of the patient (where the gender and racial identity are important).
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Multicenter Study Observational Study
Severity of SARS-CoV-2 infection and albumin levels recorded at the first emergency department evaluation: a multicentre retrospective observational study.
The aim of this study was to investigate the association between serum albumin levels in the ED and the severity of SARS-CoV-2 infection. ⋯ Albumin levels measured on presentation to the ED may identify patients with SARS-CoV-2 infection in whom inflammatory processes are occurring and serve as a potentially useful marker of disease severity and prognosis.
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Point-of-care tests for SARS-CoV-2 could enable rapid rule-in and/or rule-out of COVID-19, allowing rapid and accurate patient cohorting and potentially reducing the risk of nosocomial transmission. As COVID-19 begins to circulate with other more common respiratory viruses, there is a need for rapid diagnostics to help clinicians test for multiple potential causative organisms simultaneously. However, the different technologies available have strengths and weaknesses that must be understood to ensure that they are used to the benefit of the patient and healthcare system. ⋯ This practice review is written by members of the UK's COVID-19 National Diagnostic Research and Evaluation programme. We discuss relative merits and test characteristics of various commercially available technologies. We do not advocate for any given test, and our coverage of commercially supplied tests is not intended to be exhaustive.
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Randomized Controlled Trial
Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress: a randomised controlled trial.
To compare the efficacy of continuous positive airway pressure (CPAP) versus usual care for prehospital patients with severe respiratory distress. ⋯ The use of prehospital CPAP by EMS paramedics reduced dyspnoea and tachypnoea in patients with acute respiratory distress but did not impact hospital length of stay.