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"Emergency Department" OR "ED" OR "ER"

Luigi Mario Castello, Marco Baldrighi, Luca Molinari, Livia Salmi, Vincenzo Cantaluppi, Rosanna Vaschetto, Greta Zunino, Marco Quaglia, Mattia Bellan, Francesco Gavelli, Paolo Navalesi, Gian Carlo Avanzi, Annalisa Chiocchetti
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host-response to infections. Osteopontin (OPN) is an extracellular matrix protein involved in the inflammatory response. Our aim was to evaluate the diagnostic and prognostic performance in sepsis of a single OPN determination in the Emergency Department (ED). We conducted a single-centre prospective observational study in an Italian ED where we enrolled 102 consecutive patients presenting with suspected infection and qSOFA ≥ 2. OPN plasma concentration was found to be an independent predictor of sepsis (OR = 1...
February 18, 2019: Cells
Felipe Teran, Anthony J Dean, Claire Centeno, Nova L Panebianco, Amy J Zeidan, Wilma Chan, Benjamin S Abella
BACKGROUND: Transesophageal echocardiography (TEE) has been proposed as a modality to assess patients in the setting of cardiac arrest, both during resuscitation care and following return of spontaneous circulation (ROSC). In this study we aimed to assess the feasibility and clinical impact of TEE during the Emergency Department (ED) evaluation during out-of-hospital cardiac arrest (OHCA). MATERIALS AND METHODS: We conducted a prospective observational study consisting of a convenience sample of adult patients presenting to the ED of an urban university medical center with non-traumatic OHCA...
February 16, 2019: Resuscitation
Inga Fröding, John Karlsson Valik, Ludvig Bolinder, Pontus Nauclér, Christian G Giske
BACKGROUND: In severe infections, time to appropriate therapy is decisive for survival. Patients with bloodstream infection with extended-spectrum β-lactamase-producing Enterobacterales (EPE BSI) often receive inadequate empiric treatment. OBJECTIVES: We aimed to identify risk factors, evaluate a previously suggested risk score, and suggest a new score for facilitating empiric treatment choice. METHODS: We assessed predictors for EPE BSI through a retrospective case-control design, and evaluated diagnostic performance of the two scores...
February 16, 2019: International Journal of Antimicrobial Agents
Ithan D Peltan, Samuel M Brown, Joseph R Bledsoe, Jeffrey Sorensen, Matthew H Samore, Todd L Allen, Catherine L Hough
BACKGROUND: The impact of antibiotic timing on sepsis outcomes remains controversial due to conflicting results in prior studies. This study investigated the association of door-to-antibiotic time with long-term mortality in emergency department (ED) patients with sepsis. METHODS: This retrospective cohort study included non-trauma adult ED patients with clinical sepsis admitted to four hospitals from 2013 to 2017. Only patients' first eligible encounter was included...
February 16, 2019: Chest
Antonia Mihaela Levai, Ioana Cristina Rotar, Daniel Muresan
Uterine leiomyomas are common benign uterine tumors but by contrast, their acute complications are very rare. We present an unusual case of 38-year-old woman that came to the emergency department with acute abdominal pain. The ultrasound revealed hemoperitoneum, a uterus with two intramural fibroids and a tender inhomogeneous pelvic mass that seems to connect with the uterus. Computer tomographic (CT) examination raised the suspicion of a degenerated fibroid and hemoperitoneum. Emergency laparotomy was performed: the hemoperitoneum was determined by a degenerated fundal subserosalfibroid...
February 17, 2019: Medical Ultrasonography
Corrado Tagliati, Giulio Argalia, Gian Marco Giuseppetti
AIMS: To assess contrast enhanced ultrasound (CEUS) performance in the prediction of non-operatively managed blunt spleen injuries requiring only observation and monitoring during follow-up and to evaluate if CEUS accuracy was higher than conventional ultrasound (US) in this field. MATERIAL AND METHODS: In 112 hemodynamic stable blunt spleen trauma patients, CEUS was performed for follow-up after computed tomography evaluation in the emergency department. CEUS and US performance were assessed considering as true negative cases patients that had not underwent interventional or surgical treatment during follow-up and were assessed as negative for splenic complications respectively by CEUS or US examinations...
February 17, 2019: Medical Ultrasonography
Jashvant Poeran, Lisa J Mao, Nicole Zubizarreta, Madhu Mazumdar, Bruce Darrow, Nicholas Genes, Joseph Kannry, Paul Francaviglia, Parley D Kennelly, Jayson Whitehorn, Galen Kilroy, Dairon Garcia, David S Mendelson
OBJECTIVE: Clinical decision support (CDS) tools have been shown to reduce inappropriate imaging orders. We hypothesized that CDS may be especially effective for house staff physicians who are prone to overuse of resources. MATERIALS AND METHODS: Our hospital implemented CDS for CT and MRI orders in the emergency department with scores based on the American College of Radiology's Appropriateness Criteria (range, 1-9; higher scores represent more-appropriate orders)...
February 19, 2019: AJR. American Journal of Roentgenology
Beng Leong Lim, Si Oon Cheah, Hsin Kai Goh, Francis Chun Yue Lee, Yih Yng Ng, Wen Jia Guo, Marcus Eng Hock Ong
INTRODUCTION: Hyperoxemia in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) leads to adverse outcomes. It remains prevalent in the pre-hospital Emergency Medical Services (EMS) and Emergency Department (ED). OBJECTIVE: To determine key predictors for hyperoxemia in AECOPD in EMS and ED. METHODS: This was a prospective observational study of AECOPD patients in EMS and two EDs. Hyperoxemia was defined as PaO2 > 65 mmHg (corresponds to SpO2 > 92%)...
February 19, 2019: Clinical Respiratory Journal
Adam Lyons, Roman Romero-Ortuno, Peter Hartley
AIM: The mobility trajectories of hospitalized older people are heterogeneous, and there is a need to understand patient groups with similar trajectories. Our aims were to identify mobility trajectories of older patients admitted to geriatric wards in an English university hospital, and describe patient characteristics and outcomes associated with different mobility groups. METHODS: A retrospective observational study of first admissions to geriatric wards for 3 months starting 1 May 2016 was carried out...
February 18, 2019: Geriatrics & Gerontology International
Amanda Vandyk, Andrea Bentz, Sarah Bissonette, Caitlyn Cater
Through this qualitative study, we explored frequent emergency department use by persons with borderline personality disorder from their perspective. Interpretive description guided the study design, and data were collected through interviews with six individuals diagnosed with borderline personality disorder who had at least 12 emergency department visits for reasons related to their mental illness within a 1-year timeframe. Using thematic data analysis, we articulate the participants' experiences through two broad themes: cyclic nature of emergency department use and coping skills and strategies...
February 18, 2019: International Journal of Mental Health Nursing
Anna E Elder, Arjun Rao
AIM: Croup is a major cause of emergency department (ED) presentations, but there remains a paucity of evidence to guide clinical decision-making around which patients require admission. We aimed to describe the clinical characteristics, management and outcomes of patients presenting to the ED with croup and to identify characteristics associated with a need for further intervention. METHODS: We conducted a retrospective cohort study of all patients presenting to the ED of a tertiary paediatric hospital with croup between 2011 and 2016...
February 18, 2019: Journal of Paediatrics and Child Health
R K Davidson, S Magalini, K Brattekås, C Bertrand, R Brancaleoni, C Rafalowski, E Rostrup Nakstad
OBJECTIVE: This study investigated how European first responders and hospital personnel, along with CBRN experts, approach an overwhelming surge situation after a chemical incident. Surge capacity and capability bottlenecks were discussed. MATERIALS AND METHODS: Two chemical warfare agent (CWA) scenarios were developed: in the first, a nerve agent was released indoors; in the second, there was an outdoor explosion containing a blister agent. CBRNE experts, first responders and hospital specialists from across Europe participated in a two-day table-top exercise to discuss pre-hospital and hospital CBRNE preparedness, triage, surge capacity and communication issues...
February 2019: European Review for Medical and Pharmacological Sciences
Jessica Pflipsen, Cian McDermott, Eva Mary Doherty, Niamh Humphries
BACKGROUND: In recent years, attrition from Emergency Medicine (EM) training in Ireland has increased. Australian data illustrates that increasing numbers of Irish-trained doctors are embarking on EM training in Australia. This has implications for EM in Ireland, particularly for Emergency Departments already under strain. An adequate supply of qualified specialist EM doctors is essential to provide high-quality patient care. AIMS: The aim of this study is to gain insights into the reasons for attrition from EM training in Ireland...
February 18, 2019: Irish Journal of Medical Science
Elio Treppiedi, Lorenzo Cocchi, Giuseppe Zimmitti, Alberto Manzoni, Valeria Seletti, Alessandra Bizzotto, Cristiano Spada, Marco Garatti, Edoardo Rosso
Adult intussusception of the bowel is a rare clinical entity, and its management remains debated. The timing of treatment is not yet standardised, and no guidelines exist. We report a case of an 83-year-old woman presenting to the emergency department of our hospital with a history of increasing abdominal pain in the right iliac fossa. A contrast-enhanced computed tomography scan showed the presence of a large ileocolic intussusception with evidence of the terminal ileus invaginated within the right colon and the ileocolic vessels dragged and trapped into the intussusception...
February 18, 2019: Journal of Minimal Access Surgery
Andrew J Baxter, Emily J Tweed, Srinivasa Vittal Katikireddi, Hilary Thomson
BACKGROUND: Homelessness is associated with poor health. A policy approach aiming to end homelessness across Europe and North America, the 'Housing First' (HF) model, provides rapid housing, not conditional on abstinence from substance use. We aimed to systematically review the evidence from randomised controlled trials for the effects of HF on health and well-being. METHODS: We searched seven databases for randomised controlled trials of interventions providing rapid access to non-abstinence-contingent, permanent housing...
February 18, 2019: Journal of Epidemiology and Community Health
Sare Mıhçıokur, Gülser Doğan, Gülsüm Kocalar, Rengin Erdal, Mehmet Haberal
OBJECTIVES: In our country, there are few publications evaluating emergency department visits among kidney, liver, and heart transplant recipients. Here, we examined emergency department visits of transplant recipients after initial hospital discharge following organ transplant performed in a medical faculty hospital in Ankara, Turkey. MATERIALS AND METHODS: We retrospectively analyzed hospital records of 1144 transplant recipients (700 kidney, 332 liver, and 112 heart) who underwent living-donor and deceased-donor organ transplant procedures in a university hospital between 2007 and 2017 and were admitted to the emergency department during the same period...
January 2019: Experimental and Clinical Transplantation
Itay Zmora, Yonit Wiener-Well, Evan Avraham Alpert
BACKGROUND: Purulent bacterial pericarditis is a rare and potentially fatal disease. The course may be fulminant, and the presentation may pose a diagnostic challenge. CASE REPORT: An otherwise healthy 75-year-old male was brought to the emergency department in a state of general deterioration, confusion, and shock. Bedside ultrasound showed a significant pericardial effusion. His condition quickly deteriorated and the resuscitation included emergent bedside pericardiocentesis...
February 11, 2019: American Journal of Emergency Medicine
John R Richards, Gagan D Singh, Aman K Parikh, Sandhya Venugopal
Excluding ethanol, cannabis is the most commonly used drug in the United States and worldwide. Several published case series and reports have demonstrated an association between cannabis use and acute coronary syndrome (ACS). We report the first ever published case of ACS precipitated by cannabis use that was confirmed with concomitant rising quantitative plasma levels of 11-nor-9-carboxy-Δ9-tetrahydrocannabinol, a secondary metabolite of cannabis. A 63-year-old non-tobacco smoking male with no prior medical history presented to the emergency department with chest pain immediately after smoking cannabis, and anterior ST-segment elevation pattern was observed on his electrocardiogram...
February 13, 2019: American Journal of Emergency Medicine
Vincent J Cascone, Rose S Cohen, Nicholas P Dodson, Chad M Cannon
BACKGROUND: Previous research has illustrated the importance of collection of microbiologic cultures prior to first antimicrobial dose (FAD) in septic patients to avoid sterilization of pathogens and thus allowing confirmation of infection, identification of pathogen(s), and de-escalation of antimicrobial therapy. There is currently a lack of literature characterizing the implications and clinical courses of patients who have cultures collected after FAD. METHODS: In this single-center, retrospective chart review of 163 sepsis cases in the emergency department, the primary outcome was positive-cultures from appropriate sources...
February 13, 2019: American Journal of Emergency Medicine
Ashley D Palmer, Jodie Murphy-Oikonen
Often referred to as miscarriage, Early Pregnancy Loss (EPL) is the spontaneous death of a fetus experienced within the first 20 weeks of gestation and is the most common complication in pregnancy. Symptoms of an impending EPL are routinely managed in the Emergency Department (ED). EPL can have a substantial impact on women, potentially leading to psychological and emotional health issues and risks to future pregnancies. Despite the high prevalence of EPL, many women suffer in silence due to the common societal belief that EPL are insignificant...
February 18, 2019: Social Work in Health Care
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