The American journal of emergency medicine
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Crowding in the emergency department (ED) has multiple causes, including space and staffing in both inpatient areas and the ED. Waiting for inpatient beds is the primary issue in our ED. Waiting inpatients require continuing care and attention from emergency-medicine (EM) physicians. ⋯ We demonstrated that the TT assumed a significant patient load, an indirect measure of reduced EM physician work, but this did not improve patient satisfaction. The TT clinical role is less desirable to MLPs than are other traditional clinical roles. The TT is a potentially available, incremental staffing resource for a crowded ED.
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This study examined the effectiveness and ease of use of the ID Power Infuser, a pocket-sized device that can infuse fluid at rates up to 6 L/hr. Forty-six adults presenting with non-traumatic hypotension or clinical hypovolemia had 0.9% NaCl solution infused by the ID Power Infuser through a peripheral i.v. catheter. ⋯ Use of the Power Infuser was deemed easy (VAS = 1.9 +/- 1.9 cm). The ID Power Infuser can accurately and quickly deliver i.v. crystalloid in the ED and has the potential to reduce morbidity, time in the ED, and costs.
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The objective of this study was to evaluate the need for mandatory hospital admission of all pediatric patients with minor head injury (MHI) and negative computed tomographic (CT) scans for head injury. The study was a retrospective chart review of all patients admitted to a pediatric trauma service over a period of 4 years. MHI was defined as blunt head trauma with a Glasgow Coma Scale (GCS) score of 15 and a nonfocal neurological examination. ⋯ The most common mechanisms of injury were being struck by a motor vehicle while walking (82 patients), and falling (75 patients). No complications were observed, and although persistent symptoms occurred in 5 patients, they did not delay discharge. We conclude that pediatric patients with MHI and negative CT scans of the head do not require routine admission for observation for delayed complications.
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The diagnosis of peritonsillar abscess (PTA) poses a challenge to emergency physicians (EPs). The decision to perform an invasive procedure with potential complications is based on clinical judgment that is often inaccurate. Although there is some mention of intraoral ultrasound in otolaryngology practice, there is none in the emergency medicine (EM) literature. ⋯ All 6 patients then underwent needle aspiration. As diagnosed on ultrasound, 3 of the patients had negative aspirations and were diagnosed with peritonsillar cellulitis. Three others were found to have PTA, with 2 requiring real-time ultrasound needle guidance to accomplish abscess drainage after multiple failures with the blind approach.
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Review Case Reports
The prehospital 12-lead electrocardiogram: impact on management of the out-of-hospital acute coronary syndrome patient.
The electrocardiogram (ECG), when applied in the prehospital setting, has a significant effect on the patient with chest pain. The potential effect on the patient includes both diagnostic and therapeutic issues, including the diagnosis of acute myocardial infarction (AMI) and the indication for thrombolysis. ⋯ In AMI patients with ST-segment elevations, it has been conclusively demonstrated that information obtained from the prehospital ECG reduces the time to hospital-based reperfusion treatment. Importantly, these benefits are encountered with little increase in EMS resource use or on-scene time.