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1.
Kenneth V. Iserson Nathan G. Allan Joel M. Geiderman Rebecca R. Goett 《The American journal of emergency medicine》2019,37(12):2248-2252
Emergency physicians, organizations and healthcare institutions should recognize the value to clinicians and patients of HIPAA-compliant audiovisual recording in emergency departments (ED). They should promote consistent specialty-wide policies that emphasize protecting patient privacy, particularly in patient-care areas, where patients and staff have a reasonable expectation of privacy and should generally not be recorded without their prospective consent. While recordings can help patients understand and recall vital parts of their ED experience and discharge instructions, using always-on recording devices should be regulated and restricted to areas in which patient care is not occurring.Healthcare institutions should provide HIPAA-compliant methods to securely store and transmit healthcare-sensitive recordings and establish protocols. Protocols should include both consent procedures their staff can use to record and publish (print or electronic) audiovisual images and appropriate disciplinary measures for staff that violate them. EDs and institutions should publicly post their rules governing ED recordings, including a ban on all surreptitious or unconsented recordings. However, local institutions may lack the ability to enforce these rules without multi-party consent statutes in those states (the majority) where it doesn't exist. Clinicians imaging patients in international settings should be guided by the same ethical norms as they are at their home institution. 相似文献
2.
Eric J. Schmieler Jesse W. St Clair Joseph G. Kotora 《The American journal of emergency medicine》2018,36(11):2130.e3-2130.e5
Chest pain and shortness of breath are chief complaints frequently evaluated in the emergency department. ACS, pulmonary embolism, and disorders involving the lung parenchyma are some of the disease processes commonly screened for. Occasionally, patients presenting with histories and clinical exams consistent with these common illnesses may end up having more rare pathology. We present the case of a young patient who presented with chest pain and dyspnea with ECG changes and history concerning for pulmonary embolism who was ultimately diagnosed with idiopathic primary pulmonary hypertension. The importance of a prompt diagnosis of this condition along with emergency department management of complications related to the disease is discussed in this report. 相似文献
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M. Deborah Colony Frank Edwards Dylan Kellogg 《The American journal of emergency medicine》2018,36(4):533-539
Chest pain is a commonly encountered emergency department complaint, with a broad differential including several life-threatening possible conditions. Ultrasound-assisted evaluation can potentially be used to rapidly and accurately arrive at the correct diagnosis. We propose an organized, ultrasound assisted evaluation of the patient with chest pain using a combination of ultrasound, echocardiography and clinical parameters. Basic echo techniques which can be mastered by residents in a short time are used plus standardized clinical questions and examination. Information is kept on a checklist. We hypothesize that this will result in a quicker, more accurate evaluation of chest pain in the ED leading to timely treatment and disposition of the patient, less provider anxiety, a reduction in the number of diagnostic errors, and the removal of false assumptions from the diagnostic process. 相似文献
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Christopher Harris Jonathan Madonick Thomas Ryan Hartka 《The American journal of emergency medicine》2018,36(9):1565-1569
Objective
The objective of this study was to describe recent trends in the epidemiology of lawn mower injuries presenting to the Emergency Department in the United States using nationally representative data for all ages.Methods
Data for this retrospective analysis were obtained from the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS), for the years 2005–2015. We queried the system using all product codes under “lawn mowers” in the NEISS Coding Manual. We examined body part injured, types of injuries, gender and age distribution, and disposition.Results
There were an estimated 934,394 lawn mower injuries treated in U.S. ED's from 2005 to 2015, with an average of 84,944 injuries annually. The most commonly injured body parts were the hand/finger (22.3%), followed by the lower extremity (16.2%). The most common type of injury was laceration (23.1%), followed by sprain/strain (18.8%). The mean age of individuals injured was 46.5?years, and men were more than three times as likely to be injured as women. Patients presenting to the ED were far more likely to be discharged home after treatment (90.5%) than to be admitted (8.5%).Conclusion
Lawn mowers continue to account for a large number of injuries every year in the United States. The incidence of lawn mower injuries showed no decrease during the period of 2005–2015. Preventative measures should take into account the epidemiology of these injuries. 相似文献6.
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Byunghyun Kim Hyeonjeong Jeong Joonghee Kim Tackeun Kim Kyuseok Kim Heeyoung Lee Soyeon Ahn Yoo Hwan Jo Jae Hyuk Lee Ji Eun Hwang 《The American journal of emergency medicine》2018,36(2):271-276
Objectives
This study was performed to identify the risk factors for delayed intracranial hemorrhage and develop a risk stratification system for disposition of head trauma patients with negative initial brain imaging.Methods
The data source was National Health Insurance Service-National Sample Cohort of Korea. We analyzed adult patients presenting to the ER from January 2004 to September 2012, who underwent brain imaging and discharged with or without short-term observation no longer than two days. The primary outcome was defined as any intracranial bleeding within a month defined by a new appearance of any of the diagnostic codes for intracranial hemorrhage accompanied by a new claim for brain imaging(s) within a month of the index visit. We performed a multivariable logistic regression analysis and built a parsimonious model for variable selection to develop a simple scoring system for risk stratification.Results
During the study period, a total of 19,723 head injury cases were identified from the cohort and a total of 149 cases were identified as having delayed intracranial hemorrhage within 30 days. In multivariable logistic regression model, old age, craniofacial fracture, neck injury, diabetes mellitus and hypertension were independent risk factors for delayed intracranial hemorrhage. We constructed the parsimonious model included age, craniofacial fracture and diabetes mellitus. The score showed area under the curve of 0.704 and positive predictive value of the score system was 0.014 when the score ≥ 2.Conclusions
We found old age, associated craniofacial fracture, any neck injury, diabetes mellitus and hypertension are the independent risk factors of delayed intracranial hemorrhage. 相似文献8.
Noa P. Yee Saman Kashani Thomas Mailhot Talib Omer 《The American journal of emergency medicine》2019,37(1):177.e1-177.e4
Optic neuritis (ON) is an inflammatory condition that causes demyelination and thickening of the optic nerve leading to acute/subacute vision loss. It is frequently associated with other conditions like multiple sclerosis, but is often misdiagnosed, which can lead to a suboptimal prognosis.Ultrasound is rarely utilized to help make this diagnosis, even though it can easily detect a thickened retrobulbar optic nerve sheath diameter.We describe four cases in which ultrasonographic measurement of the optic nerve sheath diameter aided in the diagnosis of ON. 相似文献
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Kristin H. Dwyer Joshua S. Rempell Michael B. Stone 《The American journal of emergency medicine》2018,36(7):1145-1150
Objective
The study objective was to investigate the combined accuracy of right heart strain on focused cardiac ultrasound (FOCUS) and deep vein thrombosis (DVT) on compression ultrasound (CUS) for identification of centrally located pulmonary embolism (PE) diagnosed on computed tomography pulmonary angiography (CTPA).Methods
This was a prospective observational study using a convenience sample of patients undergoing CTPA in the emergency department (ED) for evaluation of PE. Patients received a FOCUS looking for right heart strain (McConnell's sign, septal flattening, right ventricular enlargement or tricuspid annular plane systolic ejection (TAPSE) < 17 mm) and a CUS looking for DVT. Ultrasounds were interpreted by both the investigator performing the ultrasound and the principal investigator independently.Results
There were 199 patients enrolled in the study, with 46/199 (23.1%) positive for a PE. Of these, 20/46 (43.5%) PE's were located centrally. Of those with a PE, 20/46 (43.5%) had an associated DVT identified on bedside ultrasound. Among patients with a proximal PE, 18/20 (90.0%) had evidence of right heart strain and the combination of lower extremity CUS and FOCUS was 100% sensitive. Diagnostic accuracy of ultrasound was much lower for peripherally located PEs.Conclusions
Emergency physician-performed bedside ultrasound may be sufficient to exclude the presence of centrally located PE, as the sensitivity in this study was 100%. Additionally, several patients with PE may qualify for early anticoagulation when DVT is identified, and further research in indicated to determine whether these patients ultimately require CTPA given identical treatment algorithms in the absence of RV strain or biomarker elevation. 相似文献10.
Alison Frizell Nicole Fogel Jacob Steenblik Margaret Carlson Joseph Bledsoe Troy Madsen 《The American journal of emergency medicine》2018,36(2):253-256
Objectives
A recent study reported a high prevalence of pulmonary embolism (PE) among patients admitted with syncope. We sought to determine whether these findings were validated in our patient population.Methods
We performed a retrospective, secondary analysis of prospectively gathered data from patients presenting with syncope to an academic emergency department (ED) from July 2010 to December 2015. We analyzed baseline information from the time of the ED visit, recorded outcomes during the hospital stay, and contacted patients by phone at least 30 days after the ED visit. The primary study outcome was the diagnosis of acute PE in the ED, during inpatient admission or ED observation unit stay, or by patient report over a 30-day follow-up period.Results
Over the 5.5-year study period, 348 patients with syncope agreed to participate in the study. 52% of patients were female [95% confidence interval (CI): 46.6–57.4] and the average age was 48.4 years. Of the enrolled patients, 50.1% (CI: 44.8–55.2) underwent further evaluation for syncope beyond the ED stay: 27% (CI: 22.6–31.9) of patients were admitted to an inpatient unit for further work-up and 23.9% (CI: 19.7–28.6) of patients were placed in the ED observation unit. The overall rate of PE among patients presenting to the ED with syncope was 1.4% (CI: 0.6–3.3%). 2 patients (0.6%, CI: 0.2–2.1) were diagnosed with a PE while in the ED. None of the patients were diagnosed with a PE during hospital admission or the observation stay associated with the index ED visit. 3 patients (0.9%, CI: 0.3–2.5) reported they had been diagnosed with a PE during the 30 days following their ED visit, two of whom had been admitted to the hospital at the index ED visit but were not diagnosed with a PE at that time. All patients diagnosed with a PE at the time of the ED visit or during the follow-up period were Pulmonary Embolism Rule Out Criteria (PERC) positive and reported shortness of breath in the ED.Conclusion
In contrast to a previous study, our findings do not support a high rate of PE among ED patients presenting with syncope. 相似文献11.
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Patrick M. Ryan Andrew J. Kienstra Peter Cosgrove Robert Vezzetti Matthew Wilkinson 《The American journal of emergency medicine》2019,37(2):237-240
Objective
To examine the safety and effectiveness of intranasal midazolam and fentanyl used in combination for laceration repair in the pediatric emergency department.Methods
We performed a retrospective chart review of a random sample of 546 children less than 18?years of age who received both intranasal midazolam and fentanyl for laceration repair in the pediatric emergency department at a large, urban children's hospital. Records were reviewed from April 1, 2012 to June 31, 2015. The primary outcome measures were adverse events and failed laceration repair.Results
Of the 546 subjects analyzed, 5.1% had multiple lacerations. Facial lacerations were the most common site representing 70.3%, followed by lacerations to the hand (9.9%) and leg (7.0%). The median length of lacerations was 1.5?cm [1.0–2.5]. The median dose of fentanyl was 2.0?μg/kg [1.9–2.0] and midazolam was 0.2?mg/kg [0.19–0.20].There were no serious adverse events reported. The rate of minor side effects was 0.7% (95% CI 0.2% to 1.9%); 0.5% (95% CI 0.1% to 1.6%) experienced anxiety and 0.2% (95% CI 0.0% to 1.0%) vomited. No patients developed hypotension or hypoxia. Of the 546 patients, 2.4% (95% CI 1.3% to 4.0%) experienced a treatment failure. 2.0% (95% CI 1.3% to 4.0%) required IV sedation and 0.4% (95% CI 0.0% to 1.3%) were repaired in the operating room.Conclusions
Our results suggest that the combination of INM and INF may be a safe and effective strategy for procedural sedation in young children undergoing simple laceration repair. 相似文献14.
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R. Andrew Taylor Arjun Venkatesh Vivek Parwani Sharon Chekijian Marc Shapiro Andrew Oh David Harriman Asim Tarabar Andrew Ulrich 《The American journal of emergency medicine》2018,36(9):1534-1539
Background
Emergency Department (ED) leaders are increasingly confronted with large amounts of data with the potential to inform and guide operational decisions. Routine use of advanced analytic methods may provide additional insights.Objectives
To examine the practical application of available advanced analytic methods to guide operational decision making around patient boarding.Methods
Retrospective analysis of the effect of boarding on ED operational metrics from a single site between 1/2015 and 1/2017. Times series were visualized through decompositional techniques accounting for seasonal trends, to determine the effect of boarding on ED performance metrics and to determine the impact of boarding “shocks” to the system on operational metrics over several days.Results
There were 226,461 visits with the mean (IQR) number of visits per day was 273 (258–291). Decomposition of the boarding count time series illustrated an upward trend in the last 2–3 quarters as well as clear seasonal components. All performance metrics were significantly impacted (p < 0.05) by boarding count, except for overall Press Ganey scores (p < 0.65). For every additional increase in boarder count, overall length-of-stay (LOS) increased by 1.55 min (0.68, 1.50). Smaller effects were seen for waiting room LOS and treat and release LOS. The impulse responses indicate that the boarding shocks are characterized by changes in the performance metrics within the first day that fade out after 4–5 days.Conclusion
In this study regarding the use of advanced analytics in daily ED operations, time series analysis provided multiple useful insights into boarding and its impact on performance metrics. 相似文献16.
Takuya Nishizawa Shigenobu Maeda Ran D. Goldman Hiroyuki Hayashi 《The American journal of emergency medicine》2018,36(1):49-55
Objective
This study aimed to determine which children with suspected appendicitis should be considered for a computerized tomography (CT) scan after a non-diagnostic ultrasound (US) in the Emergency Department (ED).Methods
We retrospectively reviewed patients 0–18 year old, who presented to the ED with complaints of abdominal pain, during 2011–2015 and while in the hospital had both US and CT. We recorded demographic and clinical data and outcomes, and used univariate and multivariate methods for comparing patients who did and didn't have appendicitis on CT after non-diagnostic US. Multivariate analysis was performed using logistic regression to determine what variables were independently associated with appendicitis.Results
A total of 328 patients were enrolled, 257 with non-diagnostic US (CT: 82 had appendicitis, 175 no-appendicitis). Younger children and those who reported vomiting or had right lower abdominal quadrant (RLQ) tenderness, peritoneal signs or White Blood Cell (WBC) count > 10,000 in mm3 were more likely to have appendicitis on CT. RLQ tenderness (Odds Ratio: 2.84, 95%CI: 1.07–7.53), peritoneal signs (Odds Ratio: 11.37, 95%CI: 5.08–25.47) and WBC count > 10,000 in mm3 (Odds Ratio: 21.88, 95%CI: 7.95–60.21) remained significant after multivariate analysis. Considering CT with 2 or 3 of these predictors would have resulted in sensitivity of 94%, specificity of 67%, positive predictive value of 57% and negative predictive value of 96% for appendicitis.Conclusions
Ordering CT should be considered after non-diagnostic US for appendicitis only when children meet at least 2 predictors of RLQ tenderness, peritoneal signs and WBC > 10,000 in mm3. 相似文献17.
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Mauro Giordano Tiziana Ciarambino Emanuela Lo Priore Pietro Castellino Lorenzo Malatino Alessandro Cataliotti Giuseppe Paolisso Luigi Elio Adinolfi 《The American journal of emergency medicine》2017,35(11):1691-1694
Study objective
We investigated the serum sodium correction rate on length of hospitalization and survival rate, in severe chronic hyponatremic patients at the Emergency Department (ED).Design
An observational study using clinical chart review.Setting
The ED of the University Hospital of Marcianise, Caserta, Italy with approximately 30,000 patients visits a year.Type of participants
We reviewed sixty-seven patients with severe hyponatremia subdivided in 2 subgroups: group A consisting of 35 patients with serum sodium correction rate < 0.3 mmol/h and group B consisting of 32 patients with serum sodium correction rate between < 0.5 and ≥ 0.3 mmol/h.Intervention
Emergency patients were evaluated for serum sodium correction rate for hyponatremia by clinical chart review.Measurements and main results
Severe hyponatremia was defined as a serum sodium level < 120 mmol/l. Mean serum sodium correction rate of hyponatremia was of 0.17 ± 0.09% in group A and 0.41 ± 0.05% in group B (p < 0.001 vs group A). The length of hospital stay was 10.7 ± 3.7 days for group A, and it was significantly decreased to 3.8 ± 0.4 days for group B (p < 0.005 vs group A). In addition we observed that correction rate of hyponatremia in group A was associated with a significantly lower survival rate (25%) in comparison to group B (60%) (p < 0.001 vs group A).Conclusion: We observed that serum sodium correction rate ≥ 0.3 and < 0.5 mmol/h was associated with a shorter length of hospital stay and a major survival rate. 相似文献19.
Matthew M. Palilonis Jeanne L. Jacoby 《The American journal of emergency medicine》2018,36(9):1720.e3
A 36yo male with multiple non-traumatic, rapid-onset headaches had Emergency Department visits on days 3 and 10 after onset of symptoms. He is a social smoker and drinker. CT head imaging was negative. An MRI/MRA was obtained. The image represents multiple foci of vasoconstriction and dilation in medium and large cerebral vessels consistent with Reversible Cerebral Vasoconstriction Syndrome (RCVS). Multiple rapid-onset headaches and "string of beads" on MRA imaging are pathognomonic for RCVS, which has a 4:1 female to male ratio. Manifestations include the pure cephalic form, characterized by a headache; subarachnoid hemorrhage and cerebral infarction have also been reported. Vasoactive drugs and the post-partum period are recognized as common inciting events. Symptoms usually resolve in 3-6 months. Treatment with nimodipine, 1-2mg/kg/hr IV and/or 30-60mg PO QID orally over 4-8 weeks, has been reported to be effective. 相似文献
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