Articles: emergency-department.
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Comparative Study
Comparing antihypertensive strategies in hypertensive emergencies with heart failure.
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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In patients with a high clinical probability of pulmonary embolism (PE), the high prevalence can lower the D-dimer negative predictive value and increase the risk of diagnostic failure. It is therefore recommended that these high-risk patients should undergo chest imaging without D-dimer testing although no evidence supports this recommendation. ⋯ In this study, ruling out PE in high-risk patients based on D-dimer below the age-adjusted threshold was safe, with no missed PE. However, the large CI of the primary endpoint precludes a definitive conclusion.
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Pediatric emergency care · Feb 2025
Observational StudyDevelopment of a Scoring Model to Predict Severe Dengue in Children at Admission in the Emergency Care: An Observational Study.
Dengue has emerged as the most widely spread mosquito-borne disease, hyperendemic in India. Although severe dengue occurs only in a small proportion of cases, delays in the recognition and management can result in significant morbidity and mortality. Risk stratification of children in the emergency care and identifying those at risk for worsening during hospital stay facilitates optimum utilization of health care resources. The objective of our study was to develop and validate a scoring model to predict the development of severe dengue in hospitalized children by identifying risk factors present in them at the time of admission to the emergency department. ⋯ The dengue severity scoring model was found to have reasonable diagnostic accuracy in predicting severe disease prior to hospitalization. However, more studies are required to validate the score in different emergency care settings with varied pediatric populations.
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Emerg Med Australas · Feb 2025
What proportion of women presenting to the emergency department with early pregnancy bleeding receive appropriate care?
To determine the proportion of women presenting to EDs across a regional health district, with early pregnancy bleeding, who received appropriate care. ⋯ Variation in care for women presenting with early pregnancy bleeding to ED was identified. There is an evidence-practice gap and need for inquiry into barriers and facilitators to prescribed clinical practice for this population.
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Early recognition of sepsis is essential for timely initiation of adequate care. However, this is challenging as signs and symptoms may be absent or nonspecific. The cascade of events leading to organ failure in sepsis is characterized by immune-metabolic alterations. Volatile organic compounds (VOCs) are metabolic byproducts released in expired air. We hypothesize that measuring the VOC profile using electronic nose technology (eNose) could improve early recognition of sepsis. ⋯ The study is embedded in the Acutelines data-biobank (www.acutelines.nl), registered in Clinicaltrials.gov (NCT04615065).