Articles: emergency-department.
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A short cut review was carried out to establish whether therapeutic anticoagulation is required for patients who have an incidental diagnosis of subsegmental pulmonary embolism (PE), which is asymptomatic. 4 studies were relevant to the three-part question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The evidence suggests that patients with clinically unsuspected PE may have better prognostic outcomes than those with symptomatic presentations, especially if the PE is at the sub-segmental level. ⋯ However, this study included patients with cancer and was not restricted to patients with subsegmental PE. Consequently, the clinical bottom line is that level 1 evidence is required to answer this question. In the meantime decisions must continue to be informed by clinical judgment.
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Observational Study
Prospective, 10-year evaluation of the impact of Hispanic ethnicity on pain management practices in the ED.
Hispanic ethnicity has been reported as an independent risk factor for oligoanalgesia in the emergency department (ED). ⋯ White and Hispanic patients were similar in rates of initial morphine administration for pain-related complaints. These findings contrast with previous studies reporting lower rates of initial analgesia administration among Hispanic patients in the ED.
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J Pain Palliat Care Pharmacother · Sep 2014
CommentTo prescribe codeine or not to prescribe codeine?
A recently published study in Pediatrics by Kaiser et al. (2014; Epub April 21, DOI: 10.1542/peds.2013-3171) reported that on average, over the past decade, children aged 3 to 17 were prescribed approximately 700,000 prescriptions for codeine-containing products each year in association with emergency department (ED) visits. Although, guidelines from the American Academy of Pediatrics issued warnings in 1997 and reaffirmed their concerns regarding the safety and effectiveness of codeine in 2006, it is still often prescribed for pain and cough associated with upper respiratory infection. With the impending rescheduling of hydrocodone combination products to Schedule II, physicians and mid-level prescribers may be compelled to prescribe codeine-containing products (e.g., with acetaminophen) due to reduced administrative burden and limits on Schedule II prescriptive authority for nurse practitioners and physician assistants in some states. This commentary expounds on the safety and effectiveness concerns of codeine, with a primary focus on patients in the ED setting.
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Differential diagnosis of seizure is critical in patients presented to emergency department (ED) with altered mental status or loss of consciousness. Although electroencephalogram is important for the diagnosis of seizures, its use in EDs is limited. The level of ischemia-modified albumin (IMA) increases in conditions of ischemic distress such as acute coronary syndrome, pulmonary embolism, and mesenteric ischemia. No studies exist in literature regarding the increase of IMA levels parallel to increased seizure activity in adults. The aim of the study was to investigate the diagnostic value of IMA in adult patients presented to ED with seizures. ⋯ Blood IMA level and IMA/albumin ratio significantly increase in adult patients who experienced seizures. Ischemia-modified albumin may be considered as a useful biomarker in the differential diagnosis of seizure.
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Can J Public Health · Sep 2014
Emergency department visits for asthma in relation to the Air Quality Health Index: a case-crossover study in Windsor, Canada.
In this study, associations of short-term changes in ambient air pollution with emergency department (ED) visits for asthma were examined in hospitals in the area of Windsor, Ontario. Ambient air pollution quality was represented by the Air Quality Health Index(AQHI), calculated using a formula that combines the concentrations and the relative health impacts of three ambient air pollutants: ozone , nitrogen dioxide and fine particulate matter. ⋯ Exposure to ambient air pollution in Windsor increases the risk of ED visits for asthma. When the adverse effects of air pollutants are increased, patient visits to the ED depend on the patient's age.