patient safety in the emergency department

... East, Abingdon, VA 24210 USA Authors’ contributions KC treated the patient in the ED and was involved in drafting the manuscript LL cared for the patient in the ED and was involved in drafting the ... assessed in triage In an era of emergency department crowding, emergency physicians should reevaluate nursing education on triaging abdominal pain to prevent delays in caring for well-appearing patients ... presentation [2] The combination of subtle presenting complaints and the need for a pelvic exam to obtain the clinical diagnosis predispose these patients to delayed diagnosis Emergency department...

Ngày tải lên: 20/06/2014, 23:20

... assay and the quantitative cardiac troponin T test in diagnosing AMI in the ED according to the time of onset of chest pain To verify whether there was any improvement in the diagnostic indices ... attending medical officers may be biased when reading the Cardio Detect® test result since they are not blinded to the history, physical examination, and ECG findings of the patient being investigated ... lower than TnT in the remaining groups, a finding that was not in keeping with previous studies [33] However, the AUC for Cardio Detect did increase over time before declining after the 24-h period...

Ngày tải lên: 20/06/2014, 23:20

... appropriate for the ED setting Meningeal biopsy and non-specific biomarkers are sometimes obtained during the inpatient evaluation Emergency department management of seizure includes benzodiazepines and ... or impingement of nerve roots or the spinal cord Careful exam and history should be used to guide the clinician in determining the need for additional imaging or other diagnostics Despite intra-reservoir ... like amitriptyline, gabapentin, carbamazepine, or benzodiazepines may be prescribed for chronic pain Acute worsening of headache, neck pain, or back pain could be related to worsening complications,...

Ngày tải lên: 21/06/2014, 01:20

... written informed consent had been obtained The remaining serum samples (collected in VACUETTE® Z Serum Sep C/A tubes) were then transferred to the investigators after being kept at the Pathology Department ... the Department of Respiratory Medicine, RHH Acute COPD sample and data collection Serum aliquots were obtained from the remaining samples after routine blood examination was performed according ... than asthma patients using albuterol at the emergency department [25] In addition, studies have shown that the significant extrapulmonary effects of inhaled albuterol, which include increased heart...

Ngày tải lên: 21/06/2014, 03:20

... (Medtronic, Inc., Minneapolis, MN) CPB was initiated within 10 minutes of the decision for its use and 58 minutes after the arrival of the patient to the ED; the patient' s core temperature was 25°C An initial ... tin time was 32.6 seconds, and international normalized ratio was 1.23 It was determined that he had sustained a myocardial infarction during his perihypothermic time interval (creatinine kinase ... 60 minutes of conventional warming therapies that included warm fluid instillation (intravenous, gastric, and intrapleural), use of a warming blanket, and CPR in a trauma room that was 27°C The...

Ngày tải lên: 11/08/2014, 23:21

... intensive care unit of other hospitals, were included in the study than phlebotomy for the study proteins Three groups of patients were defined based on clinical findings, on laboratory findings, ... fulfilling the SIRS criteria, was present in 36.2% of the infected patients and in 18.4% of the noninfected patients (P < 0.001) (Table 4) In patients with SIRS (n = 69), there was no difference in the ... showed convincing results in detecting infection in immunosuppressed and leukopenic patients, shall we assay PCT routinely in all these patients? Further studies with a special focus to the immunosuppressed...

Ngày tải lên: 12/08/2014, 20:20

... Milrinone Dopexamine Combined Dopamine Epinephrine Vasomotor Norepinephrine Phenylephrine Vasopressin resuscitation outcomes (Table 3) Adequacy and timing of acute resuscitation, as well as definitive ... and noninvasive measurement for the diagnosis and estimation of the severity of shock in the ED Gastric mucosal and sublingual PCO2 are measured using tonometric catheters inserted into the stomach ... may be necessary for delivering high inspired oxygen concentration and eliminating the work of breathing during resuscitation in the ED Elimination of work of breathing can reduce systemic oxygen...

Ngày tải lên: 12/08/2014, 20:20

... certainty in the effects of interventions provided in the ED; improving the understanding of existing physiologic measurements and their influence on outcomes; reducing variations in individual clinical ... scoring systems developed specifically for prognosticating outcome in ED patients Scoring systems in the intensive care unit Intensivists have used a variety of physiologic scoring systems in clinical ... Scoring System (TISS) evaluates the need in staffing, monitoring, and therapeutic intervention rather than stratifying severity of illness Patients are assigned to a class from I to IV, ranging...

Ngày tải lên: 12/08/2014, 22:21

... critically ill patients in the ED is incomplete The primary objective of this study is to determine the length of stay of critically ill patients receiving care in a tertiary care adult emergency department ... (30/56, 53.6%) had the CVC inserted within the first hours of admission to the ICU Similarly, arterial catheters were inserted in 99/178 patients (55.6%) with 14.1% (14/99) inserted in the ED and 71.7% ... undergo invasive procedures while in the emergency department Further research on the importance of ED LOS of critically ill patients is suggested 14 15 Clark K, Normile LB: Patient flow in the emergency...

Ngày tải lên: 13/08/2014, 23:20

... forms during the stay in the emergency department and entered in a database created for the purpose of the study Patients treated on an outpatient basis were not included In cases where the data ... score in the first 15 minutes after admission to the emergency department and VSSmax denotes the maximum VSS score throughout the total stay in the emergency department Hence, VSSmax represents the ... score during the stay in the emergency department was assessed in a multivariate logistic regression model including VSS initial and the increase in VSS points (VSSmax - VSSinitial) as predictors...

Ngày tải lên: 14/08/2014, 07:21

... Canadian Clinical Practice Guidelines) Recommendations are similar to the ones in the United States: Beta2-agonists are the first-line therapy for the management of acute asthma in the emergency department; ... Guidelines in USA With understanding of the importance of management in the emergency room, numerous clinical guidelines on acute exacerbation of asthma have been disseminated In November 1997, the ... Zealand, and the Singapore Ministry of Health in 2002 Though some specific steps are different among these guidelines, the outline of the main points is the same, containing four sections: Measures...

Ngày tải lên: 26/09/2015, 11:07

... protocol for the management of stable adult patients presenting to the emergency department with fever as their chief complaint and no localizing symptoms The overarching goal of the protocol ... while the remainder underwent investigation per the protocol at the 3- and 5-day follow-up Among the 48 patients presenting within the first days of fever who underwent investigations outside of the ... defervescence The investigations were contributory to patient management in 25.0% (12/48) of these cases and did not change management in the remaining 75.0% (36/48) Four patients were lost to follow-up Investigations...

Ngày tải lên: 21/06/2014, 00:20

... All pregnant patients who participated in the study had presented with pregnancy-related complaints of abdominal pain and/or vaginal bleeding Research associates were present in the ED days per ... spaces in which the patient recorded this information Utilizing self-reported race, patients were grouped according to reported race using United State Census classifications [14] In evaluating ... and MA provided significant contribution in the writing and revision of the manuscript Competing interests The authors declare that they have no competing interests Received: February 2011 Accepted:...

Ngày tải lên: 21/06/2014, 02:20

... they were either discharged or referred by the emergency room physician Total ED length of stay was defined as the time the patient arrived in the ED until the time they left the ED, either after ... emergency department (ED) visit length of stay, and total emergency department (ED) length of stay ED visit length of stay was defined as the time the patient arrived in the ED until the time they ... disputed data The intra-rater reliability was determined using the Cohen’s kappa rating, aiming for a minimum inter-rater reliability of 80% All three sites used Troponin I (cTnI) as their cardiac...

Ngày tải lên: 21/06/2014, 03:20

... views, and CT, if clinically indicated Results In all, 8,283 patients were included in the final analysis [44] Among all the patients, 169 (2.0%) had clinically important CSI In 845 patients (10.2%), ... required by the Canadian C-Spine Rule, and were categorized as indeterminate cases Seven of these 845 patients had clinically important CSI In the analysis that excluded the indeterminate cases, the ... entered into the study Patient eligibility will be determined based on these criteria at the time of arrival in the ED "Trauma to the head and neck" will include patients with either: i) neck pain...

Ngày tải lên: 11/08/2014, 05:22

... were recorded at the same time points Methylergonovine was administered intravenously diluted in ml of saline at an initial dosage of 0.15 mg If pain intensity was still above in pain VAS, an additional ... (NSAID) Methods The study was done in the Emergency Departments of two hospitals of the district of Santa Marta, in Colombia Inclusion criteria were female adult patients experiencing migraine with ... (***: p < Pain intensity over the monitored time period (***: p < 0.0001 in relation to baseline; ES: effect size) (74.4%) patients 60 minutes after dosing Only one of the patients requiring an additional...

Ngày tải lên: 11/08/2014, 20:20

... 1) on the ROC curve The discrimination ability of the final model was quantified by using the area under the ROC curve with its 95% CI The calibration of the final model was assessed using the ... (in 12 patients) and Pneumocystis carinii pneumonia (in one patient) The main diagnoses of the patients are summarized in Table Agreement between the two experts occurred in 89% of cases for the ... infection; in 33 of these patients the infection was acute and in two it was chronic (without an alternative aetiology for the fever) A total of 41 patients were deemed to be in the 'other' category, including...

Ngày tải lên: 13/08/2014, 03:21

... the etiological diagnosis of the emergency physician found in the medical chart, we observed that administration of antibiotics was not always in accordance with that diagnosis, emphasizing the ... issue of the prescription of antibiotics and the potential added value of biomarkers like PCT Therefore we think that the next important steps in assessing PCT diagnostic values are the following: ... Firstly, assess the LR in subgroups of patients, according to the pretest probability determined by the physician; secondly, test an algorithm that includes PCT measurement; thirdly, test the usefulness...

Ngày tải lên: 13/08/2014, 08:21

... waiting times Interestingly, the relative differences in LOS between the EDs (Figure 4) were similar to the differences in physician waiting times (Figure 7), indicating that that they are linked ... unclear, but according to the leadership in ED C, the pattern in ED C may be related to hospital crowding with admitted patients waiting in the ED for an in- hospital bed The LOS pattern in ED C and ... collected In one of the EDs, aggregated data were obtained that enabled drilling down into accumulated data without identifying individual patients Data collection and processing The following patient...

Ngày tải lên: 13/08/2014, 23:20

... The Arrhythmic Patient in the Emergency Department Massimo Zecchin • Gianfranco Sinagra Editors The Arrhythmic Patient in the Emergency Department A Practical Guide for Cardiologists and Emergency ... made in patients who came to the ED for other diseases Emergency physician is the first doctor approaching the patient and must initially define the hemodynamic state induced by the arrhythmia The ... Arrhythmic Patients in the Emergency Department: General Principles Alessandro Surian and Luca Visintin Syncope: First Evaluation and Management in the Emergency Department...

Ngày tải lên: 10/06/2016, 20:20