Articles: hospital-emergency-service.
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Observational Study
Assessment of frontal QRS-T angle in distinguishing mild and severe acute pancreatitis in emergency department: A retrospective study.
Acute pancreatitis (AP) is a disease that poses significant health risks with potential severe outcomes. Identifying markers for severity can aid in early intervention and improve prognoses. This study, conducted in the emergency department, investigates the QRS-T angle as a potential indicator of severity in patients with acute pancreatitis. ⋯ Additionally, severe pancreatitis group showed higher QRS-T angle (P < .001), higher rates of abnormal QRS angles (31.8% vs 10.1%, P = .002), and QRS-T angles (31.8% vs 8.1%, P < .001). The QRS-T angle may serve as a valuable clinical tool for differentiating between mild and severe forms of acute pancreatitis. This could potentially help clinicians in stratifying patients according to their risk and tailoring their management accordingly.
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We implemented a "kit in hand" naloxone distribution program at emergency department (ED) discharge activated by electronic health record Best Practice Advisory (BPA). The purpose of this study was to evaluate naloxone kit distribution before and after implementation. ⋯ Implementation of a BPA-activated kit in hand naloxone distribution program increases the rate of successful naloxone distribution to patients presenting to the ED following unintentional opioid overdose, a subpopulation at very high risk for recurrence of overdose. Opportunities for program improvement were identified as there were instances where kits were intended to be distributed but barriers in the process existed.
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A short-cut systematic review was conducted using a described protocol. The three-part question addressed was: In adult patients presenting to the ED with diabetes-related visual symptoms, how effective is using a portable handheld fundus camera in diagnosing diabetic retinopathy?MEDLINE, Embase and Cochrane databases were searched for relevant evidence. Altogether, 237 papers were found using the search strategy developed. 12 provided the best evidence to answer the three-part question. ⋯ Jin et al (2017) demonstrated high-quality images with 63% rated as excellent, showing a comparable efficacy to a traditional tabletop camera. Das et al (2022) found that Remidio and Pictor handheld cameras had high success rates and image quality, with sensitivities of 77.5% (95% CI: 65.9% to 89.0%) and 78.1% (95% CI: 66.6% to 89.5%), respectively, comparable to the Zeiss tabletop camera's sensitivity of 84.9% (95% CI: 78.2% to 91.5%). The clinical bottom line is that the best available evidence supports the effectiveness of portable handheld fundus cameras for diagnosing diabetic retinopathy in emergency settings.
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Multicenter Study Observational Study
Subarachnoid haemorrhage in the emergency department (SHED): a prospective, observational, multicentre cohort study.
People presenting to the ED with acute severe headache often undergo investigation to exclude subarachnoid haemorrhage (SAH). International guidelines propose that brain imaging within 6 hours of headache onset can exclude SAH, in isolation. The safety of this approach is debated. We sought to externally validate this strategy and evaluate the test characteristics of CT-brain beyond 6 hours. ⋯ Our data suggest a very low likelihood of SAH after a negative CT-brain scan performed early after headache onset. These results can inform shared decision-making on the risks and benefits of further investigation to exclude SAH in ED patients with acute headache.
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Olanzapine long-acting injection is a commonly used antipsychotic drug formulation in the treatment of schizophrenia. Postinjection delirium/sedation syndrome (PDSS) is a potential side effect of this intramuscular depot, for which patients are often presented at the ED. In this article, we give an overview of the current literature outlining the key aspects of managing this syndrome in a critical care setting, illustrated by a typical fictional clinical case. We discuss several useful and practical aspects of PDSS for emergency physicians and critical care physicians, including pharmacological background, common symptoms, diagnostic criteria and therapeutic options.