Articles: emergency-department.
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Shared decision making (SDM) is a process whereby patients and clinicians work together to make informed medical decisions that incorporate patient values. Recent data suggest that, for patients with low pretest probability of pulmonary embolism (PE), doubling the standard d-dimer cutoff may reduce the need for imaging with minimal increase in missed PE diagnoses. We used an SDM approach to determine patient preferences regarding this diagnostic approach. ⋯ When presented with a hypothetical scenario, more than one-third of patients deferred imaging for PE based on low clinical probability and a d-dimer less than twice the normal threshold. An SDM approach is acceptable to patients and may decrease imaging for PE.
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Pediatric emergency care · Mar 2014
Development of a survey of teamwork and task load among medical providers: a measure of provider perceptions of teamwork when caring for critical pediatric patients.
Teamwork training focuses on improving patient outcomes through better communication. Scales exist to assess providers' perceptions of teamwork; however, they are not designed for use immediately after the care of critically ill patients. ⋯ The Survey of Teamwork and Task Load among Medical Providers was developed to evaluate providers' perceptions of teamwork immediately after care of critically ill patients in a pediatric emergency department. Items reflect 2 constructs, with good internal consistency. Responses did not vary by professional training, suggesting that it is useful for all providers. Both factors predicted the overall smoothness. Each was useful in predicting the perception that the resuscitation went smoothly.
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The use of Emergency Medical Services (EMS) for low-acuity pediatric problems is well documented. Attempts have been made to curb potentially unnecessary transports, including using EMS dispatch protocols, shown to predict acuity and needs of adults. However, there are limited data about this in children. The primary objective of this study is to determine the pediatric emergency department (PED) resource utilization (surrogate of acuity level) for pediatric patients categorized as "low-acuity" by initial EMS protocols. ⋯ While this EMS system did not well predict overall resource utilization, it safely identified most low-acuity patients, with a low under-triage rate. This study identifies subgroups of patients that could be managed without emergent transport and can be used to further refine current protocols or establish secondary triage systems.
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Pediatric emergency care · Mar 2014
Case ReportsUltrasound-Guided Intra-articular Lidocaine Block for Reduction of Anterior Shoulder Dislocation in the Pediatric Emergency Department.
We report a case of successful reduction of an anterior shoulder dislocation after ultrasound-guided intra-articular lidocaine (IAL) block with subsequent sonographic confirmation of reduction. Current literature suggests that IAL can provide similar levels of analgesia as intravenous sedation, and IAL block is associated with lower complication rates and shorter emergency department stays. However, these studies may be limited by uncertainty about the accuracy of landmark-based glenohumeral injections. The use of beside ultrasound may improve the effectiveness of IAL block for reduction of anterior shoulder dislocation and provide a mechanism for immediate postreduction evaluation of the placement of the humeral head.
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Ulus Travma Acil Cer · Mar 2014
Are neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as effective as Fournier's gangrene severity index for predicting the number of debridements in Fourner's gangrene?
Fournier's gangrene (FG) is a rapidly progressive and necrotizing infection of the subcutaneous and fascial tissues with a high mortality rate. In the present study, we aimed to investigate prognostic factors and analyze the outcomes of 68 patients in a tertiary reference hospital. ⋯ The FGSI scoring system was not found to be valuable in determining prognosis. However, NLR and PLR were valuable, and previous use of NLR and PLR for determining Fournier's gangrene prognosis could not be found in the English literature.