Articles: emergency-department.
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Pediatric emergency care · Jul 2022
The Outcome of Cerumen Removal in the Pediatric Emergency Department.
Cerumen obstructs the visualization of the tympanic membrane (TM) in up to 40% of children, sometimes posing a challenge to rule out the diagnosis of acute otitis media (AOM) as the source of otalgia (for verbal children), irritability, fever, and febrile seizures. We aim to determine the rate at which removing the cerumen from blocking the view of the TM could change the management of these patients in the pediatric emergency department (PED). ⋯ Cerumen removal changes the management of children in the PED who present with a possible diagnosis of an ear infection. Cerumen removal could avoid unnecessary laboratory and imaging studies, which could save time, costs, and suffering.
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The COVID-19 pandemic has profoundly affected the habits of patients, as well as its negative effects on human health. The aim of this study is to investigate the factors associated with discharge against medical advice (DAMA) from the emergency department (ED) during the COVID-19 pandemic. ⋯ During the COVID-19 pandemic period, it was observed that the rate of those with severe disease increased among DAMA cases. Necessary precautions should be taken for all patients, especially seriously ill patients, to feel safe in the hospital and to be treated, and the negative consequences that may develop should be prevented by addressing the concerns of the patients and their relatives.
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To analyze trends in admission rates and the proportion of admissions via the ED at rural hospitals in Pennsylvania and to identify factors that may impact admission rates. ⋯ Emergency departments are the gatekeepers of admissions at rural acute care hospitals in Pennsylvania. Many hospitals in rural Pennsylvania, including CAHs, are admitting most of their patients through the ED, concomitant with a significant decline in admissions and admission rates. This highlights the need to strengthen primary care practices serving rural Pennsylvania as well as the need to improve rural emergency and trauma systems. In the short to medium term, policy makers should explore innovative ways to fund smaller hospitals, especially CAHs, to develop level IV trauma center capabilities.
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Pre-excitation syndrome can either mimic or mask myocardial infarction, making the diagnosis of acute myocardial infarction difficult. Herein, we report the case of a male patient with Wolf-Parkinson-White (WPW) syndrome who presented to our emergency department with severe chest pain. ⋯ One month later, he underwent successful radiofrequency catheter ablation for his accessory pathway and tachycardia. We present the series of electrocardiographic ST-T abnormalities to raise awareness of the value of diagnosing myocardial injury early in patients with WPW syndrome.
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Pediatric emergency care · Jul 2022
Self-Reported Usage of Safety Equipment Provided Through a Community Partnership Approach to Injury Prevention in the Pediatric Emergency Department.
Previous studies have shown that educational programs in conjunction with provision of free or low-cost safety equipment increases the likelihood of parents changing behaviors at home. This project surveyed caregivers in the pediatric emergency department (ED) about safety behaviors before and after provision of education and safety equipment related to medication storage, firearm storage, and drowning. ⋯ Families often report unsafe home storage of medications and firearms, which together account for a large amount of morbidity and mortality in pediatrics. Drowning risk for young children is ubiquitous in the home setting, and low rates of use of home safety devices indicates need for further education and outreach on making the home environment safe. Despite relying on self-reported behaviors and the risk of reporting bias skewing the data, the behaviors reported in the preintervention survey were still very unsafe, suggesting that children may have a much higher risk of injury in the actual home environments. The ED is traditionally thought of as a place to receive care when injuries happen, but any encounter with families should be seen as an opportunity for injury prevention messaging. Partnering with a local school of public health and other community resources can result in the establishment of a low-cost, consistent, and effective injury prevention program in the pediatric ED that reaches a large number of individuals without the added burden of additional tasks that take time away from already busy ED providers and staff.