Articles: emergency-department.
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Elderly patients often have atypical clinical presentations. Lactate measurement on arrival at the Emergency Department (ED) could be useful to identify elderly patients with a bad prognosis. ⋯ Serum lactate measured at ED arrival has a significant and exponential relationship with inhospital mortality and ICU admission in elderly patients.
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Acute exacerbations of chronic obstructive pulmonary disease (COPD) in the emergency department (ED) involve dyspnea, cough, and chest discomfort; frequent exacerbations are associated with increased mortality and reduced quality of life. Noninvasive positive pressure ventilation (NiPPV) is commonly used to help relieve symptoms but is limited due to patient intolerance. We aimed to determine whether high-velocity nasal insufflation (HVNI) is noninferior to NiPPV in relieving dyspnea within 4 h in ED patients with acute hypercapnic respiratory failure. ⋯ In participants with symptomatic COPD, HVNI was noninferior to NiPPV in relieving dyspnea 4 h after therapy initiation. HVNI may be a reasonable treatment option for some patients experiencing moderate acute exacerbations of COPD in the ED.
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Emerg Med Australas · Dec 2024
Evaluating accuracy of cervical spine computed tomography interpretation by emergency trainees with the use of a structured protocol.
Radiological evaluation of cervical spine injury with computed tomography (CT) scanning is a fundamental component of the assessment of major trauma. Accurate interpretation of scans is essential for safe clearance or diagnosis of injuries. However, delays in radiologist reporting often result in prolonged spinal immobilisation. The aim of the present study was to evaluate a simple, structured reporting tool to improve assessment of CTs of the cervical spine by emergency medicine trainees. ⋯ Interpretation of cervical spine CT scans by trainees was inferior compared to radiologists and did not improve with a structured reporting template. Other innovative strategies towards timely reporting of CT scans by radiologists of the cervical spine are indicated for earlier definitive diagnosis.
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Background and Objectives: In patients with acute coronary syndrome, electrocardiographic parameters, including ST elevation in lead aVR (aVR-STE), ST depression (aVR-STD), and QTc prolongation, are crucial. This study aims to show the predictive value of a longer QTc in emergency department patients with acute coronary syndrome and ≥1 mm ST elevation or depression in the aVR lead in electrocardiography. Materials and Methods: A retrospective analysis was conducted on 1273 patients admitted to the emergency department with a preliminary diagnosis of acute coronary syndrome between 2020 and 2023. ⋯ In the uni-multivariable regression analysis performed for both change in aVR derivation and mortality, it was determined that prolonging QTc could be a predictive value for acute coronary syndrome (p < 0.001). We found sensitivity at 99.7% and specificity at 99.2% in predicting mortality in patients with prolonged QTc (AUC: 0.983, 95% CI: 0.974-0.993, p < 0.001). Conclusions: In patients with acute coronary syndrome, a prolonged QTc is an independent predictor of short- and long-term mortality in alterations in aVR derivation.