The American journal of emergency medicine
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The objective was to compare the accuracy of abdominal sonography performed by emergency physicians in the diagnosis of acute appendicitis with that of the surgeons' clinical impression. Three hundred-seventeen patients with right lower abdominal pain admitted to the Department of Emergency Medicine at National Taiwan University Hospital in Taipei, Taiwan were prospectively included in this study. Patients were divided into two groups according to the time of day they visited the emergency department. ⋯ The definitive diagnosis of acute appendicitis was confirmed by the pathological reports. In the diagnosis of acute appendicitis, group I had a sensitivity of 96.4%, a specificity of 67.6%, a positive predictive value of 89.8%, a negative predictive value of 86.2%, and an accuracy of 89.1%, and group II had a sensitivity of 86.2%, a specificity of 37.0%, a positive predictive value of 74.6%, a negative predictive value of 55.6%, and an accuracy of 70.6%. The overall accuracy of sonography performed by emergency physicians in the diagnosis of acute appendicitis was superior to that of the surgeons' clinical impression.
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Alteration of mental status secondary to medical illness may occasionally be incorrectly attributed to a psychiatric problem. The cases of 64 patients with unrecognized medical emergencies inappropriately admitted to psychiatric units from emergency departments were reviewed to determine the cause of the misdiagnoses. ⋯ Other common causes of misdiagnosis included inadequate physical examination (43.8%), failure to obtain indicated laboratory studies (34.4%), and failure to obtain available history (34.4%). A systematic approach is required for patients with altered mental status, including those with psychiatric presentations.
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The purpose of this study was to examine the emergency department (ED) management of hypothermic cardiac arrest and its outcome. The medical records of all patients with hypothermic cardiac arrest treated in the ED from January 1, 1988 to January 31, 1999 were retrospectively reviewed. Data collected included initial body temperature, serum potassium, methods of rewarming, return of perfusing rhythm, and morbidity and mortality. ⋯ In two of these patients a perfusing rhythm had been established after thoracotomy in the ED and before transport to the operating room for cardiac bypass. Only one of seven (14.3%) patients who arrested prehospital survived versus four of four (100%) who arrested in the ED. ED thoracotomy with internal cardiac massage and mediastinal irrigation rewarming is effective in the management of hypothermic cardiac arrest.
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The objective of this retrospective study was to identify factors affecting the accuracy of pulse oximetry in the ED. Over a 3-year period, 664 consecutive emergency department (ED) patients had simultaneous arterial blood gas (ABG) and pulse oximeter readings taken. Pulse oximeter saturations (SpO2) were compared with ABG CO-oximeter saturations (SaO2) for accuracy. ⋯ If COHb is > or =2%, sensitivity is 0.74 and specificity is 0.84. For patients likely to have a COHb < 2, pulse oximetry is an effective screening tool for detecting hypoxia. However, more caution must be exercised when using pulse oximetry in patients likely to have a COHb > or = 2%.
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The study objective was to determine the impact on quality of care, resource use, and outcomes by developing an emergency department (ED)-based asthma-specific care plan. The design was a time based, prospective cohort and set at an urban university/trauma center, EM residency site, combined adult/pediatric department. Best practice was defined prospectively for ED asthma patients, leading to an asthma care plan (ACP). ⋯ ACP+ group had more timely beta agonist treatment (93% versus 74%, P < .01), shorter LOS (3.29 +/- 1.90 vs. 3.53 +/- 1.86 hrs, P < 0.5) more appropriate steroid dosages (67% versus 41%, P < .01), and fewer tests (41% versus 59%, P < .05). No improvements were noted in admission or relapse rates. In conclusion, care plans can improve quality of care and decrease LOS, but may have limited impact on outcomes of admission/discharge or relapse rates.