Articles: emergency-medicine.
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Over the past decade, Emergency Department (ED) patient volumes have increased more than available hospital ICU capacity. This has led to increased boarding and crowding in EDs, requiring new methods of providing intensive care. Many hospitals nationwide have developed ICU boarding mitigation strategies at the hospital and ED level or implemented ED-based resuscitative care units to improve patient care and disposition. However, these have been described in the setting of larger medical centers without broader application to rural, community ED environments. The authors herein have created an ED model utilizing a physician and nurse on-call team to provide improved care to critically ill patients requiring resuscitation when an ICU bed is not immediately available. ⋯ Over a twelve-month period, the authors describe a novel rural community-based mobile critical care team. This team demonstrated the ability to quickly arrive at bedside, continue resuscitation, acquire a disposition, and provide individualized critical are. This model serves as a roadmap for developing similar community based-resuscitation programs.
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Patients leaving against medical advice (AMA) can be distressing for emergency physicians trying to navigate the medical, social, psychological, and legal ramifications of the situation in a fast-paced and chaotic environment. To guide physicians in fulfilling their obligation of care, we aimed to synthesize the best approaches to patients leaving AMA. ⋯ A systematic approach to patients leaving AMA could help improve patient care, support physicians and decrease stigmatization of this population. We advocate that emergency physicians should receive training on how to approach patients leaving AMA to limit the impact on this vulnerable population.
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Notfall Rettungsmed · Jan 2023
Review[Polytrauma care in air rescue in times of the COVID-19 pandemic: impact and development of case numbers].
Changes in patient care occurred as a result of the SARS-CoV‑2 virus, and both intrahospital and prehospital care were profoundly affected. Public shutdowns during lockdown periods were intended to prevent overstretching existing resources, resulting in noticeable changes in medical care for both elective treatments and emergency medicine. This study now considered the impact of the COVID 19 pandemic on air ambulance services at a central air ambulance site in 2020 compared to the previous 2 years. ⋯ During the COVID-19 study period, a decrease in the number of deployments and aborted deployments was observed. However, no significant differences in deployment and injury characteristics were observed for trauma-related deployments. These results highlight the importance of air ambulance services to ensure patient care even during pandemic periods.
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Case Reports
Massive MCA stroke requiring alteplase followed by thrombectomy in a 34-year-old female with alport syndrome.
34-year-old-female with a medical history significant for Alport's syndrome, chronic kidney disease on dialysis, and hypertension, was brought to the emergency department for sudden onset aphasia and facial droop that began 30 min prior to arrival. She denied a history of prior strokes, recent illness, or fever. The vital signs on arrival as follows: blood pressure 151/71 mmHg, temperature of 98.4F, pulse of 77 beats/min, and respirations of 16 breaths/min. ⋯ The patient underwent MRI that showed a large left MCA distribution acute infarction with focal reperfusion hemorrhage and parenchymal hematoma measuring approximately 3 cm in each dimension (Fig. 3). This finding prompted emergent decompression and hemicraniectomy on day 2 of hospitalization. The patient was discharged on hospital day 17 to a rehab center.
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Wien. Klin. Wochenschr. · Jan 2023
Impact of noninvasive ventilation at a municipal emergency department on ICU admissions.
In 2015, the emergency department of a municipal hospital in Vienna began to perform noninvasive ventilation (NIV) on patients admitted for acute respiratory failure, given no intubation criteria were met. The intention of this study was to show to which type of hospital unit patients were transferred after undergoing NIV in the emergency department. Additionally, the impact of the underlying disease, a patient's sex and age and the year of intervention were analyzed. ⋯ These findings emphasize the importance of noninvasive ventilation at the emergency department in reducing load on intensive care units and ensuring an efficient hospital workflow. Nonintensive care admission rate appears to be the highest in patients with pulmonary edema, especially in the higher age range and is also associated with the level of staff training. Prospective trials are needed to accurately confirm these correlations.