Annals of emergency medicine
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Multicenter Study
Analysis of current management of atrial fibrillation in the acute setting: GEFAUR-1 study.
Limited information relative to the management of atrial fibrillation in the emergency department (ED) daily practice is available. This study evaluates current management of atrial fibrillation in this setting to identify areas for practice improvement. ⋯ In our ED population, rate-control effectiveness is poor and rhythm control is not attempted in most recent-onset episodes. Methods to improve rate-control effectiveness, the selection of patients for rhythm control, and the use of electrocardioversion appear warranted.
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Although it is considered standard of care to obtain blood cultures on patients hospitalized for pneumonia, several studies have questioned the utility and cost-effectiveness of this practice. The objective of this study is to determine the impact of emergency department (ED) blood cultures on antimicrobial therapy for patients with pneumonia. ⋯ Blood cultures rarely altered therapy for patients presenting to the ED with pneumonia. More discriminatory blood culture use may potentially reduce resource utilization.
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Randomized Controlled Trial Comparative Study
Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access.
We assess the success rate of emergency physicians in placing peripheral intravenous catheters in difficult-access patients who were unsuccessfully cannulated by emergency nurses. A technique using real-time ultrasonographic guidance by 2 physicians was compared with traditional approaches using palpation and landmark guidance. ⋯ Ultrasonographic-guided peripheral intravenous access is more successful than traditional "blind" techniques, requires less time, decreases the number of percutaneous punctures, and improves patient satisfaction in the subgroup of patients who have difficult intravenous access.
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Electronic surveillance systems often monitor triage chief complaints in hopes of detecting an outbreak earlier than can be accomplished with traditional reporting methods. We measured the accuracy of a Bayesian chief complaint classifier called CoCo that assigns patients 1 of 7 syndromic categories (respiratory, botulinic, gastrointestinal, neurologic, rash, constitutional, or hemorrhagic) based on free-text triage chief complaints. ⋯ Our results suggest that, for most syndromes, our chief complaint classification system can identify about half of the patients with relevant syndromic presentations, with specificities higher than 90% and positive predictive values ranging from 12% to 44%.