Journal of the American College of Emergency Physicians open
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J Am Coll Emerg Physicians Open · Oct 2020
Comparative prospective study of the performance of chest pain scores and clinical assessment in an emergency department cohort in Singapore.
Chest pain scores allow emergency department (ED) physicians to identify low-risk patients for whom discharge can be safely expedited. Although these have been extensively validated in Western cohorts, data in patients of Asian heritage are lacking. This study aimed to determine the accuracy of HEART, ED Assessment of Chest Pain Score (EDACS), and Global Registry of Acute Coronary Events (GRACE) in risk-stratifying which chest pain patients are at risk of major adverse cardiovascular events within 30 days (composite of all-cause mortality, acute myocardial infarction and coronary revascularization). ⋯ HEART more accurately identified low-risk chest pain patients in an Asian ED, demonstrating comparable performance characteristics to clinical judgment. This has major implications on the use of chest pain scores to safely expedite disposition decisions for low-risk chest pain patients.
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J Am Coll Emerg Physicians Open · Oct 2020
Pediatric respiratory distress: California out-of-hospital protocols and evidence-based recommendations.
Prehospital protocols vary across local emergency medical service (EMS) agencies in California. We sought to develop evidence-based recommendations for the out-of-hospital evaluation and treatment of pediatric respiratory distress, and we evaluated the protocols for pediatric respiratory distress used by the 33 California local EMS agencies. ⋯ Protocols for pediatric respiratory distress vary widely across the state of California, especially among those for stridor (croup) and wheezing in < 24 months (bronchiolitis). The evidence-based recommendations that we present for the prehospital treatment of these conditions may be useful for EMS medical directors tasked with creating and revising these protocols.
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J Am Coll Emerg Physicians Open · Oct 2020
The utility of pediatric age-based weight estimation formulas for emergency drug dose calculations in obese children.
In obese children, when drug therapy is required during emergency care, an estimation of ideal body weight is required for certain drug dose calculations. Some experts have previously speculated that age-based weight estimation formulas could be used to predict ideal body weight. The objectives of this study were to evaluate how accurately age-based formulas could predict ideal body weight and total body weight in obese children. ⋯ The age-based formulas were substantially less accurate at estimating total body weight and ideal body weight than existing length-based methods such as the PAWPER XL tape, and should not be used for this purpose.
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J Am Coll Emerg Physicians Open · Sep 2020
Rapid reorganization of the Milan metropolitan public safety answering point operations during the initial phase of the COVID-19 outbreak in Italy.
To quantify how the first public announcement of confirmed coronavirus disease 2019 (COVID-19) in Italy affected a metropolitan region's emergency medical services (EMS) call volume and how rapid introduction of alternative procedures at the public safety answering point (PSAP) managed system resources. ⋯ With sudden escalating EMS call volumes, rapid reorganization of dispatch operations using tailored algorithms and specially assigned personnel can protect EMS system resources by optimizing patient dispositions, controlling ambulance allocations and mitigating hospital impact. Prudent population-based disaster planning should strongly consider pre-establishing similar highly coordinated medical taskforce contingencies.
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J Am Coll Emerg Physicians Open · Sep 2020
Dynamic emergency department response to the evolving COVID-19 pandemic: the experience of a tertiary hospital in Singapore.
The coronavirus disease 2019 (COVID-19) pandemic has placed large stressors on emergency departments (EDs) worldwide. As the pandemic progressed, EDs faced changing patient epidemiology and numbers. ⋯ The principles behind our response include guiding ED operations with data, enhancing infection control practices, and being prepared to transform areas of the ED to care for different groups of patients. Our experience can serve to guide other EDs in planning their response to surge capacity and ED operations during such pandemics.