The American journal of emergency medicine
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Intracranial complications of pediatric sinusitis are rare but potentially life threatening. These complications include cavernous sinus thrombosis, orbital infection, meningitis, and subdural empyema. Children with these complications may experience significant morbidity from their infection. ⋯ Emergency physicians, pediatricians, and otolaryngologists should maintain a high index of suspicion for this complication of disease when treating patients with sinusitis in the emergency department or outpatient clinic. Early and accurate diagnosis of subdural empyema will lead to prompt treatment and a favorable outcome for the patient. We report a case of subdural empyema secondary to frontal sinusitis in an otherwise healthy immunocompetent adolescent boy.
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Well over half of all US hospital patients are now admitted directly through the emergency department (ED) rather than scheduled through the admissions department by a referring member of the medical staff. This study sought to understand hospital-level variation in the percentage of admissions originating in the ED. ⋯ The increasing rate of admissions from the ED department is a national trend, but there is substantial variation at the hospital level. In Florida, measures of hospital scale and an older population with some limitations in access to, or the quality of, primary care are the factors influencing hospital-level variation. Factors implicated in increased ED use such as ED visit acuity, lack of insurance, and race are not important contributory variables. The process of admission and, particularly, the role of the organized medical staff in this process are evolving, and the consequences of these changes require further research.
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The aim of this study was to investigate whether emergency department (ED) patients who were newly diagnosed with atrial fibrillation (AF) displayed risk factors for incident AF on prior ED visits. ⋯ Nearly 40% of patients diagnosed with new AF had previous ED visits and displayed validated risk factors for incident AF. The ED provides an opportunity to identify and educate these patients as well as refer them for primary prevention interventions.
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Because baclofen is eliminated mostly by the kidney, baclofen-related encephalopathy is usually found in patients with renal failure. Therefore, hemodialysis has been suggested for those patients to alleviate symptoms and shorten recovery time. We present a case of baclofen intoxication with normal renal function benefiting from hemodialysis. ⋯ Hisconsciousness returned 9 hours after hemodialysis was finished, and he was extubated smoothly thereafter. The elimination half-life of baclofen before and during hemodialysis was 15.7 and 3.1 hours, respectively. As patients with baclofen overdose could have prolonged elimination even with normal renal function, hemodialysis would be beneficial to those patients with normal renal function.
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The purpose of this study is to develop and validate the excess mortality ratio-based Emergency Severity Index (EMR-ESI) that feasibly and objectively assesses the severity of emergency department (ED) patients based on their chief complaints. ⋯ The EMR-ESI was notably useful in predicting hospital mortality and the admission of emergency patients.