The American journal of emergency medicine
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Observational Study
Impact of device selection and clip duration on lung ultrasound assessment in patients with heart failure.
Pulmonary edema is a common sign of heart failure and can be quantified by counting vertical artifacts (B-lines) on lung ultrasound (LUS). The primary aim of this study was to compare a pocket size ultrasound device to high-end ultrasound systems on the measured number of B-lines. We also compared the impact of different-length ultrasound clips on the measured number of B-lines. ⋯ Our findings suggest significant differences based on LUS clip duration rather than the type of ultrasound device used, with respect to the number of B-lines detectable in patients with heart failure. These factors should be considered in the design and reporting of LUS studies and in longitudinal assessments of heart failure patients.
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Observational Study
Lack of adverse effects from flumazenil administration: an ED observational study.
Flumazenil is an effective benzodiazepine (BZD) antagonist. Empiric use of flumazenil in the emergency department (ED) is not widely recommended due to concerns of seizures, which are commonly associated with coingestants and BZD withdrawal. ⋯ A majority of patients had improved mental status after the administration of flumazenil. No patient experienced seizures. Additional studies that clarify the role of flumazenil for ED patients with suspected BZD toxicity are warranted.
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The objectives of this study are to describe an emergency department (ED) adult population with the chief complaint of mental and behavioral disorders due to psychoactive substance use and to investigate sex- and age-related differences. ⋯ Mental and behavioral disorders due to psychoactive substance use account for 1.3% of ED visits. Older people should be screened for chronic alcohol consumption. Our findings underscore the opportunity provided by the ED for screening and brief intervention in drug- and alcohol-related problems.
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The inferior vena cava (IVC) parameters, including its diameter and collapsibility index have been evaluated for fluid status for over 30 years, but little is known about the impacts of patient characteristics on IVC parameters. The purpose of this study was to explore the relationships between individual patient characteristics and IVC parameters in healthy Chinese adult volunteers. ⋯ The percentage collapse of IVC and the IVCmax are not substantially influenced by patient characteristics. In contrast, the IVC/Ao index is more susceptible to patient characteristics than IVC.
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Our objectives were to determine the frequency of patient transfers to a tertiary care emergency department (Tertiary ED) due to a lack of radiology services in rural hospital EDs (Rural EDs), and examine the community and patient attributes that are associated with these transfers. ⋯ Lack of radiology services in Rural EDs leads to numerous patient transfers to the Tertiary ED each year. A disproportionate number of these transfer patients are African American. These transfers place additional financial and social burdens on patients and their families. This study discusses these findings and alternative diagnostic options (ie, telemedicine and ultrasound video transfer) to address the lack of radiology services available in Rural EDs. The use of these alternate diagnostic options will likely reduce the number of patient transfers to Tertiary EDs.