The American journal of emergency medicine
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Emergency department (ED) clinicians are not typically involved in the long-term management of patients' anticoagulation therapy, but they are responsible for decision making for emergency conditions requiring anticoagulation, such as acute venous thromboembolism (VTE). In addition, emergency physicians are often faced with patients who present first to the ED with conditions that may prompt long-term anticoagulation upon hospital discharge, such as atrial fibrillation (AF), or who have acute or potential bleeding complications from anticoagulation. ⋯ Knowledge of the appropriate clinical use and safety concerns of the new anticoagulants is imperative as they become more frequently prescribed, and their potential uses in the ED setting represent an important aspect of continuing education for emergency physicians.
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Randomized Controlled Trial
An electrocardiogram technician improves in-hospital first medical contact-to-electrocardiogram times: a cluster randomized controlled interventional trial.
In the case of chest pain, the current guidelines require electrocardiogram (ECG) recording and patient assessment within 10 minutes upon arrival in the emergency department. ⋯ Delays of iFMC-to-ECG can be effectively addressed by implementation of an ECG-T. The service of an ECG-T is feasible and improves staff satisfaction. Both ECG-to-EP time and ECG assessment constitute no relevant delay.
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Randomized Controlled Trial
Chest compressions performed by ED staff: a randomized cross-over simulation study on the floor and on a stretcher.
Multiple factors may contribute to the observed survival variability following in-hospital cardiopulmonary resuscitation (CPR). While in-hospital CPR is most often performed on patients lying on a bed or stretcher, CPR training uses primarily manikins placed on the floor. We analyzed the quality of external chest compressions (ECC) in simulated cardiac arrest scenarios occurring both on a stretcher and on the floor. ⋯ The quality of chest compressions performed by ED staff was below 2005 guideline standards, with decreased ECC depth during CPR on a stretcher. Annual refresher courses should be implemented in the ED, with a focus on obtaining required ECC depth while standing next to a stretcher.
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The objective of this study is to evaluate the diagnostic performance of the BinaxNow Influenza A&B rapid antigen test (RAT) in emergency department (ED) patients. ⋯ The BinaxNow RAT demonstrated high specificity and poor sensitivity in ED patients selected by treating clinicians for influenza testing. A negative RAT is a poor predictor for the absence of influenza in the ED and should not be used as a criterion to withhold antiviral medications.
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Case Reports
Jejunojejunum intussusception as the single initial manifestation of Henoch-Schönlein purpura in a teenager.
We described a 14-year-old boy with initial presentation of recurrent intermittent abdominal pain, with subsequent development of jejunojejunum intussusception. The characteristic purpuric skin rash of Henoch-Schönlein purpura appeared later after the surgical manual reduction. When abdominal pain is the single initial manifestation in patients with undiagnosed Henoch-Schönlein purpura, emergency physicians should evaluate if the patient required early surgical intervention such as intussusception or perforation and always keep Henoch-Schönlein purpura as a possibility in mind.