Annals of emergency medicine
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We identify factors associated with delayed emergency department (ED) antibiotics and determine feasibility of a 1-hour-from-triage antibiotic requirement in sepsis. ⋯ The quality improvement intervention significantly reduced antibiotic delays, yet most septic patients did not receive antibiotics within 1 hour of triage. Compliance with the 2018 Surviving Sepsis Campaign would require a wholesale alteration in the management of ED patients with either vague symptoms or absence of triage hypotension.
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Observational Study
Pediatric Out-of-Hospital Traumatic Cardiopulmonary Arrest After Traffic Accidents and Termination of Resuscitation.
We describe the characteristics and outcomes of pediatric traumatic out-of-hospital cardiac arrest after traffic accidents and validate the termination of resuscitation clinical criteria for adult traumatic out-of-hospital cardiac arrest in pediatrics. ⋯ The outcomes of pediatric patients with traumatic out-of-hospital cardiac arrest after traffic accidents were as poor as those of adults in previous studies. Out-of-hospital return of spontaneous circulation was a significant indicator of favorable outcomes, and the duration of out-of-hospital CPR beyond which the possibility of favorable neurologic outcomes and survival diminished to less than 1% was 15 minutes. Termination of resuscitation criteria provided an excellent positive predictive value for 1-month unfavorable neurologic outcomes after out-of-hospital cardiac arrest.
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We aim to characterize the incidence and risk factors for opioid-related and all-cause mortality in the year after an emergency department (ED) visit for nonfatal opioid poisoning by conducting a population-based study. ⋯ We identified predictors of opioid-related and all-cause mortality after ED presentation for opioid poisoning. Several predictors of mortality may facilitate targeted interventions.
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Case Reports
Circumferential Partial-Thickness Burn Caused by Mobile Telephone Charger: A Case Report.
Many children and adolescents have access to portable electronic devices. Although not always the case, these devices are often charged at nighttime, especially while being used in bed. There are increasing media reports of electric current injury from the portable electronic devices' charging cables, particularly with equipment that is available for lower cost from generic manufacturers. ⋯ She likely sustained an electrical injury from the charger as it came in contact with her necklace, causing a burn. Several companies have investigated the difference in quality and safety of generic versus Apple-brand chargers and have found that the majority of the generic chargers fail basic safety testing, making them a higher risk for electrical injury. As a result of this case, patients and families should be educated about safe use of these devices, especially while they are charging.