Articles: emergency-department.
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6.2 million Americans live with heart failure (HF) and are at risk for hospitalization due to hypertensive emergencies. Optimal treatment strategy for acute hypertensive heart failure remains unclear. Our study investigates what treatment modality is most effective in achieving guideline-directed blood pressure control. ⋯ Acute hypertensive heart failure was managed adequately with any treatment modality. Use of IV bolus therapy in these patients was associated with shorter ICU length of stay. Our results add to growing evidence that hypertensive emergencies may be less clinically significant than previously thought.
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skin lacerations are one of the main causes of children's referral to the emergency department (ED). We introduced in our general ED a pediatric sedo-analgesia protocol (SAP) for suturing skin wounds using LAT gel, a local anesthetic solution of lidocaine, adrenaline and tetracaine, with or without low-dose oral midazolam according to patient's age, to improve the experience of laceration repair. ⋯ The introduction of a LAT gel and low-dose oral midazolam SAP allows an improvement of both the sedo-analgesia provided and the ED operators' suturing experience of skin lacerations in children. Our SAP appeared to be safe and effective, with low cost and high tolerability.
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Burnout in healthcare workers is a global issue, with Emergency Medicine (EM) particularly impacted. Many countries have tried implementing wellness initiatives to reduce burnout and improve wellness. This paper summarizes interventions implemented in Canada to-date with the aim of supporting the design of wellness interventions in EDs globally. ⋯ Examples include educational programs, dedicated sessions for compassion literacy and resilience, critical events debriefing, and optimizing shift schedules. Structured wellness curriculums seem to be effective, and this area warrants further study. Moreover, we identify a need for global collaboration to build wellness programs and for more easily translatable standardized outcome measures for assessing the efficacy of wellness programs in EM.
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Pediatric emergency care · Dec 2024
Impact of the Amount of Intravenous Glucose Administration on Hospitalization for Acute Gastroenteritis in a Pediatric Emergency Department.
In case of failure of oral rehydration, children with acute gastroenteritis can be hydrated using intravenous (IV) solution. The choice of the intravenous solution itself (solutions containing dextrose versus crystalloids alone) and the glucose quantities to administer are not well established. ⋯ There was a wide practice variation in intravenous glucose provided to children with acute gastroenteritis. In this population, higher intravenous glucose amount was associated to a lower risk of hospitalization and lower risk of return visit.
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Pediatric emergency care · Dec 2024
Pediatric Emergency Medicine Physicians' Perspectives of Concussion in Young Children.
Traumatic brain injury (TBI) during early childhood (before 6 years) is prevalent, accounting for rising rates of emergency department visits. These injuries may lead to postconcussive symptoms, which may be subtle and difficult to diagnose in young children. Inadequate discharge counseling may lead to prolonged duration of symptoms and possible developmental delays. We aimed to explore pediatric emergency medicine (PEM) physicians' perspectives on "concussion" terminology, diagnosis, and management, specifically in a young child with mild TBI. ⋯ Variability exists among PEM physicians in diagnosis and management of concussions in young children. Discomfort with lack of reliability of symptoms and underappreciation of typical early childhood characteristics may account for findings. Educational initiatives, age-appropriate clinical tools and treatment-guided outcomes research are needed to guide PEM physicians in the care of young children with head injuries.