Articles: emergency-department.
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The authors examined the clinical characteristics of homeless patients presenting to emergency departments (EDs) in the United States, with a focus on unintentional and intentional injury events and related comorbid conditions. ⋯ A better understanding of the injuries affecting homeless populations may provide medical and public health professionals insight into more effective ways to intervene and limit further morbidity and mortality related to specific injury outcomes.
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Comparative Study
Senior patients with moderate to severe pain wait longer for analgesic medication in EDs.
Delayed pain treatment is a common problem in emergency departments (EDs). The objective of this study was to examine the effect of age on time to ED patients receiving the first analgesic dose for moderate to severe pain. ⋯ Seniors with moderate to severe pain wait 1.1 hours (55.2%) longer than younger patients to receive analgesics. Physicians and nurses (32 and 35 minutes, respectively) contributed to this disparity.
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Mid-regional pro-atrial natriuretic peptide (MR-proANP), procalcitonin (PCT), and mid-regional pro-adrenomedullin (MR-proADM) demonstrated usefulness for management of emergency department patients with dyspnea. ⋯ In patients admitted for dyspnea, assessment of PCT plus MR-proADM improves risk stratification and management. Combined use of biomarkers is able to predict in the total cohort both rehospitalization and death at 30 and 90 days.
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In the United States, more than 115,000 patients are wait-listed for organ transplants despite that there are 12,000 patients each year who die or become too ill for transplantation. One reason for the organ shortage is that candidates for donation must die in the hospital, not the emergency department (ED), either from neurologic or circulatory-respiratory death under controlled circumstances. ⋯ In this article, we assert that in uDCDD, all efforts at saving lives are exhausted before organ donation is considered, and death is determined according to "irreversible cessation of circulatory and respiratory functions" evidenced by "persistent cessation of functions during an appropriate period of observation and/or trial of therapy." Therefore, postmortem in vivo organ preservation with chest compressions, mechanical ventilation, and extracorporeal membrane oxygenation is legally and ethically appropriate. As frontline providers for patients presenting with unexpected cardiac arrest, emergency medicine practitioners need be included in the uDCDD debate to advocate for patients and honor the wishes of the deceased.
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Emerg Med Australas · Apr 2014
'Did not waits': A regional Australian emergency department experience.
Describe the characteristics, reasons for leaving and outcomes of patients who did not wait (DNW) to be seen by a health practitioner in a regional Australian ED. ⋯ Regional Australia ED patients who DNW often still require medical care, with approximately 1 in 20 requiring subsequent hospital admission. Patients with psychiatric conditions who DNW might be at particular risk.