Annals of emergency medicine
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Letter Case Reports
Recurrent seizure activity in a child after acute vilazodone ingestion.
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Multicenter Study
Toward understanding the difference between using patients or encounters in the accounting of emergency department utilization.
Descriptions of emergency department (ED) census often do not differentiate between patients and encounters, and there is no guidance about which unit of analysis is most appropriate. We explore differences between patient- and encounter-level accounting of ED utilization. ⋯ EDs provide care to a relatively static population, with truly new patients composing only a minority of encounters. Although multiple encounters per patient are common, highly frequent use occurs for only a minority of ED patients, and then only for a discrete period. Encounters and patients are not equivalent units of analysis, and policymakers and researchers should determine which is most appropriate for their decisionmaking.
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Multicenter Study
Association between repeated intubation attempts and adverse events in emergency departments: an analysis of a multicenter prospective observational study.
Although repeated intubation attempts are believed to contribute to patient morbidity, only limited data characterize the association between the number of emergency department (ED) laryngoscopic attempts and adverse events. We seek to determine whether multiple ED intubation attempts are associated with an increased risk of adverse events. ⋯ In this large Japanese multicenter study of ED patients undergoing intubation, we found that multiple intubation attempts were independently associated with increased adverse events.
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Sgarbossa's rule, proposed for the diagnosis of acute myocardial infarction in the presence of left bundle branch block, has had suboptimal diagnostic utility. We hypothesize that a revised rule, in which the third Sgarbossa component (excessively discordant ST-segment elevation as defined by ≥5 mm of ST-segment elevation in the setting of a negative QRS) is replaced by one defined proportionally by ST-segment elevation to S-wave depth (ST/S ratio), will have better diagnostic utility for ST-segment elevation myocardial infarction (STEMI) equivalent, using documented coronary occlusion on angiography as reference standard. ⋯ Replacement of the absolute ST-elevation measurement of greater than or equal to 5 mm in the third component of the Sgarbossa rule with an ST/S ratio less than -0.25 greatly improves diagnostic utility of the rule for STEMI. An unweighted rule using this criterion resulted in excellent prediction for acute coronary occlusion.