Articles: emergency-department.
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Pediatric emergency care · Aug 2014
Review Case ReportsA 6-year-old girl with undiagnosed hemophagocytic lymphohistiocytosis and takotsubo cardiomyopathy: a case report and review of the literature.
Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder of highly stimulated immune responses to antigens that leads to life-threatening inflammation and multiple organ dysfunction. At presentation, HLH may uncommonly mimic septic shock. In this case, we present a 6-year-old girl presenting to the pediatric emergency department with a febrile illness and anemia that subsequently developed decompensated shock, initially thought to be septic. ⋯ During initial HLH treatment, this patient also developed takotsubo cardiomyopathy, a unique pattern of reversible left ventricular dysfunction characterized by transient apical ballooning and hypokenesis of the left ventricle that spontaneously resolves. There are very few case reports of HLH-associated takotsubo cardiomyopathy. We believe that this is the first case of takotsubo cardiomyopathy in a child with HLH.
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Admission on weekends and off-hours has been associated with poor outcomes and mortality from acute stroke. The purpose of this study was to investigate whether an organized clinical pathway (CP) for ischemic stroke can effectively reduce the time from arrival to evaluation and treatment in the emergency department (ED) and improve outcomes, regardless of the time from arrival in the ED. ⋯ An organized CP, based on CPOE, for ischemic stroke can effectively attenuate disparities in the time interval between ED arrival to evaluation and treatment regardless of ED arrival time. This pathway may also help to eliminate off-hour and weekend effects on outcomes from ischemic stroke.
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Emerg Med Australas · Aug 2014
Randomized Controlled TrialSenior work-up assessment and treatment team in an emergency department: A randomised control trial.
To evaluate the impact of a senior early assessment model of care on performance measures in a single ED. ⋯ A senior early assessment model of care was not associated with improved overall NEAT performance and ED length of stay. However, there is evidence that improvements were made in the subgroup of discharged patients. There was no difference in overall NEAT performance among the three study groups.
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The actively bleeding anticoagulated patient presenting to the emergency department requires rapid evaluation and treatment, which is made increasingly complicated by the ever-evolving antithrombotic treatment options used in medicine. Even with excellent supportive care, the timeliness with which reversal decisions need to be made continues to demand of the emergency practitioner a familiarity with the properties and general characteristics of a variety of antithrombotic agents. Reversal options vary and may include vitamin K, FFP, PCC, rFVIIa, platelets, and desmopressin, among others.
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Patients with anemia are frequently encountered in the emergency department (ED); emergency physicians (EPs) often play an important role in the evaluation and management of anemia. Although many patients have findings consistent with anemia on routine laboratory tests, only a small percentage will require acute intervention. An understanding of the broader types of anemia and how to manage such patients is important in the practice of an EP, as the presence of anemia will impact treatment plans for a variety of other disorders. This article reviews the evaluation and management of adult patients presenting to the ED with anemia.