Annals of emergency medicine
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Central line-associated bloodstream infections (CLABSI) cause preventable morbidity and mortality. Hospitals have reduced CLABSI by using a bundle of evidence-based infection prevention practices. Systems factors in the emergency department (ED) present unique barriers to bundle adoption, and no guidelines exist for bundle implementation. We aim to identify barriers and facilitators to central line bundle adoption in EDs. ⋯ The strategies for implementing and sustaining a central line infection prevention bundle in the ED are distinct from those of other clinical settings. Our findings describe the central line bundle workflow in the ED, staff motivations, and the critical systems factors that impede and foster its use. Knowledge of these systems factors should improve bundle adoption in the ED and thereby reduce hospital incidence of CLABSIs.
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Acute exertional compartment syndrome is an uncommon illness that occurs after a period of strenuous exercise. We present a case of acute exertional compartment syndrome of the bilateral supraspinatus muscles after weight lifting. The diagnosis was made in the emergency department and the patient subsequently underwent successful decompressive fasciotomies of both compartments. We highlight the unusual presentation of this case and the approach to make the diagnosis.
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Editorial Comment
Value and Evidence-Based Medicine: A Call for Shared Responsibility.