Articles: emergency-department.
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Multicenter Study
Epidemiologic and clinical characteristics and course of acute heart failure and cardiogenic shock diagnosed in emergency departments.
To describe the characteristics of patients diagnosed with acute heart failure (AHF) in emergency departments (EDs) who develop cardiogenic shock (CS) not associated with ST-segment elevation acute coronary syndrome (STACS). ⋯ CS occurring outside a context of STACS is uncommon in ED patients with AHF and is related to poorer functional class. More of these patients have valve disease, hyponatremia, and non-STACS as a precipitant. Nearly 40% die in hospital. Almost a third die in the ED.
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Eur J Trauma Emerg Surg · Dec 2024
Comparative Study Observational StudyComparison of scoring systems for patients with head injury presenting to the emergency department.
The present study aimed to compare the National Emergency X-Radiography Utilization Study II (NEXUS-II), New Orleans Criteria (NOC), Canadian Computed Tomography (CT) Head Rule (CCTHR) scoring systems, and Advanced Trauma Life Support (ATLS®) 10th edition algorithm in patients with head injury presenting to the emergency department and to investigate the effectiveness of these scoring systems in determining injury severity and the need for cranial CT scanning. ⋯ In our region, there was no significant difference among the CCTHR, NEXUS-II systems, and ATLS algorithm regarding the accuracy of pathological findings in patients with head injury; any of these systems can be used in clinical practice and determining CT scan necessity. Although the sensitivity of the NOC system is very high, it has been observed that its low specificity may lead to a large number of unnecessary CT scans, which may increase the patient-based cost and waiting time in the emergency department.
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Hidden infections and late diagnoses are currently the main challenges of the HIV pandemic. Emergency departments (EDs) are one of the health care system's key resources addressing these challenges. In 2020, the Spanish Society of Emergency Medicine (SEMES) published recommendations for ordering HIV serology testing for patients with certain health conditions, and in 2021 SEMES launched the "Leave Your Mark" (Deja tu Huella - DTH) program to facilitate implementing the recommendations during emergency care. ⋯ One out of every 5 new HIV diagnoses in Spain is now made in an ED, but there is still room for improvement. To that end, this paper contributes 7 concrete proposals: 1) update the DTH program's criteria for ordering serology by including unexplained thrombocytopenia, fever with no focus of infection, and former residence in a country with endemic HIV infection; 2) include serology for hepatitis C virus infection at the time HIV testing is ordered; 3) reinforce the importance of obtaining the patient's informed consent for testing, meeting the obligation to respect the individual's rights; 4) implement educational programs; 5) develop decision-making tools (forms for ordering tests, alerts in patients' histories); 6) involve nurses in the DTH process and value their contributions; and 7) monitor quality markers to evaluate implementation of the program in all participating hospitals. The ultimate goal is to improve the DTH program and ensure its sustainability over time.