The T2Bacteria Assay Is a Sensitive and Rapid Detector of Bacteremia That Can Be Initiated in the Emergency Department and Has Potential to Favorably Influence Subsequent Therapy

BackgroundBacteremia causes a major worldwide burden, in terms of financial and productivity costs, as well the morbidity and mortality it can ultimately cause. Proper treatment of bacteremia is a challenge because of the species-dependent response to antibiotics. The T2Bacteria Panel is a U.S. Food and Drug Administration–cleared and culture-independent assay for detection of bacteremia, including common ESKAPE pathogens—Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa—and provides species identification in as little as 3.6 h directly from blood.ObjectiveOur aim was to evaluate the T2Bacteria assay performance and potential to affect patient care in the emergency department (ED).MethodsED patients from a Louisiana and Florida center were enrolled as part of the T2Bacteria Panel clinical study, which was prospective and noninterventional. Blood samples for blood culture (BC) and T2Bacteria were matched in time and anatomic location.ResultsData from 137 ED patients were evaluated. Relative to BC, T2Bacteria showed 100% positive percent agreement and 98.4% negative percent agreement. In addition, for species on the T2Bacteria Panel, the T2Bacteria assay detected 25% more positives associated with infection, and on average identified the infectious species 56.6 h faster. The T2Bacteria assay covered 70.5% of all species detected by BC. Finally, relative to actual care, the T2Bacteria assay could have potentially focused therapy in 8 patients, reduced time to a species-directed therapy in 4 patients, and reduced time to effective therapy in 4 patients.ConclusionsIn this ED population, the T2Bacteria assay was a rapid and sensitive detector of bacteremia from common ESKAPE pathogens and showed the theoretical potential to influence subsequent patient therapy, ranging from antibiotic de-escalation to faster time to effective therapy.     

Imaging in noncardiovascular thoracic emergencies: a pictorial review

Cardiovascular and noncardiovascular conditions are commonly encountered in the emergency department. While the majority of patients have underlying cardiovascular aetiologies, such as acute myocardial infarction, congestive heart failure, aortic dissection and pulmonary embolism, a small subset of patients have underlying noncardiovascular conditions, although they present with similar symptoms of chest pain, dyspnoea, cough, haemoptysis and haematemesis. This article aims to describe the imaging findings in common noncardiovascular conditions of the chest that are frequently encountered in the emergency department, with a review of the existing literature.     

The Effect of Homelessness on Patient Wait Times in the Emergency Department

BackgroundProlonged emergency department (ED) wait times could potentially lead to increased morbidity and mortality. While previous work has demonstrated disparities in wait times associated with race, information about the relationship between experiencing homelessness and ED wait times is lacking.ObjectivesThe purpose of this study was to explore the relationship between residence status (undomiciled vs. domiciled) and ED wait times. We hypothesized that being undomiciled would be associated with longer wait times.MethodsWe obtained data from the National Hospital Ambulatory Medical Care Survey from 2014 to 2017. We compared wait times in each triage category using t tests. We used multivariate linear regression to explore associations between residence status and wait times while controlling for other patient- and hospital-level variables.ResultsOn average, undomiciled patients experienced significantly longer mean ED wait times than domiciled patients (53.4 vs. 38.9 min; p < 0.0001). In the multivariate model, undomiciled patients experienced significantly different wait times by 15.5 min (p = 0.0002). Undomiciled patients experienced increasingly longer waits vs. domiciled patients for the emergent and urgent triage categories (+33.5 min, p < 0.0001, and +22.7 min, p < 0.0001, respectively).ConclusionsUndomiciled patients experience longer ED wait times when compared with domiciled patients. This disparity is not explained by undomiciled patients seeking care in the ED for minor illness, because the disparity is more pronounced for urgent and emergent triage categories.     

院前急救对重症脑出血患者的抢救效果

〔摘 要〕 目的：探析重症脑出血患者急救措施。方法：选取 2019 年 3 月至 2020 年 8 月在遂溪县人民医院进行急救的 135 例重症脑出血患者为研究对象，依据是否实施院前急救将其分成两组，观察组 68 例患者实施急救措施，对照组 67 例患 者未实施院前急救。比较两组患者的急救效果。结果：观察组患者治疗总有效率为 97.05 %，显著高于对照组的 74.63 %， 差异具有统计学意义（P ＜ 0.05）。观察组患者并发症发生率明显低于对照组，差异具有统计学意义（P ＜ 0.05）。观察组 患者的各项生存质量评分均高于对照组，差异具有统计学意义（P ＜ 0.05）。观察组患者死亡率为 1.47 %（1/68），对照组 死亡率为 4.48 %（3/67），差异无统计学意义（P ＞ 0.05）。结论：对于重症脑出血患者而言，对患者实施及时的院前急救 可以有效降低患者入院之前的危险性，提高生存质量，降低死亡率。     

优化急诊护理对急性心肌梗死患者抢救效果的影响

目的评价急性心肌梗死(心肌梗死)患者抢救期间配合应用优化急诊护理干预对抢救效果的影响。方法选择本院收治的急性心肌梗死患者,总计80例。除抢救治疗外,给予患者随机分组进行护理干预,对照组40例急性心肌梗死患者采取常规急诊护理,试验组40例急性心肌梗死患者采取优化急诊护理干预。比较对照组与试验组急性心肌梗死患者组间分诊评估时间、急救总时间、住院时间、救治成功率、护理满意度。结果经优化急诊护理的试验组急性心肌梗死患者的分诊评估、急救以及住院时间均少于对照组,护理满意度高于对照组(P<0.05)。另外,组间救治成功率比较(P>0.05)。结论急性心肌梗死患者抢救中运用优化急诊护理可以缩短患者抢救时间、提高抢救成功率。     

上呼吸道感染致高热惊厥患儿的综合护理分析

目的探讨综合护理在小儿上呼吸道感染致高热惊厥中的应用效果。方法选取2017年5月—2019年6月在本院急诊科就诊的上呼吸道感染致高热惊厥患儿60例,其中2017年5月—2018年5月降温急救护理实施前收治的30例患儿为对照组,2018年6月—2019年6月降温急救护理实施后收治的30例患儿为观察组。对照组给予常规急救护理,观察组采用综合护理。对比两组康复指标、护理满意度及惊厥复发情况。结果观察组干预后两组体温恢复时间(27.33±5.32)h、惊厥控制时间(4.37±1.07)d、住院时间(5.98±1.57)d,短于对照组,差异有统计学意义(P<0.05);观察组总护理满意度(93.33%)比对照组(70.00%)更高,差异有统计学意义(P<0.05);观察组复发率(3.33%)比对照组(26.67%)更低,差异有统计学意义(P<0.05)。结论降温综合护理可缩短呼吸道感染致高热惊厥患儿症状恢复时间,提升护理满意度,降低惊厥复发风险,值得应用。     

虚拟现实技术在急诊医学教育中的探索与实践

目的探讨虚拟现实技术在急诊医学教育中应用的可行性和教学效果。方法对徐州某高校急救与救援医学专业48名本科生,在教学过程中随机分为对照组(24人)和虚拟现实教学组(24人),对比分析两组急诊医学专业课(创伤医学、急救医学和灾害医学)的成绩,评价虚拟现实技术在急诊医学教育中的效果。结果对照组创伤医学、急救医学、灾害医学三门专业课成绩分别为:(73.6±8.3)分、(76.2±9.5)分、(73.8±8.1)分;而虚拟现实教学组三门专业课成绩分别为:(85.3±5.2)分、(87.4±6.2)分、(92.6±5.5)分,均高于对照组,差异有统计学意义。结论与传统教学方法相比,虚拟现实技术在急诊医学教育中具有一定的优越性,是适应当前急诊医学教育人才培养的一种好的教育教学方法。     

急诊眩晕症实施不同药物治疗疗效及安全性

目的针对急诊眩晕症患者通过实施不同药物进行治疗,观察及分析临床疗效。方法选取本院收治的急诊眩晕症患者108例,经随机分为对照组、氯丙嗪组、阿托品组、异丙嗪组,分别给不同药治疗后观察4组患者药物在治疗前后阶段的临床效果。结果与对照组相比,其他3组患者其总有效率均出现明显升高,组间差异存在统计学意义(P<0.05)。经治疗后,其他3组发生眩晕的次数改善效果均较好且安全性程度较高。结论对不同药物用于眩晕症稳定型眩晕治疗效果较为明显,不良反应大大降低,安全度高,不仅增强患者生活质量水平,且在急诊科中具有重要参考价值及意义。     

《新型冠状病毒感染的肺炎疫情紧急心理危机干预指导原则》专家解析

新型冠状病毒肺炎疫情是一次突发的公共卫生危机事件,不仅威胁人们的身体健康,也会给大众带来心理冲击,引起相应的心理行为问题。2020年1月26日,国家下发《新型冠状病毒感染的肺炎疫情紧急心理危机干预指导原则》,本文从由谁提供(心理危机干预服务)、给谁提供、提供什么、怎么提供、注意事项5个方面对上述指导原则总体内容进行概括整理,并提出几点思考,以帮助提供相关服务的精神心理工作人员更好地理解和实施指导原则。