The American journal of emergency medicine
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Observational Study
Venous lactate in predicting the need for intensive care unit and mortality among nonelderly sepsis patients with stable hemodynamic.
Our study aims to investigate the role of initial venous lactate in predicting the probability of clinical deterioration and 30-day mortality in nonelderly sepsis patients with acute infections, without hemodynamic shock. ⋯ In nonelderly sepsis patients with stable hemodynamic, elevated venous lactate (≥2 mmol/L) was associated with an increased probability of the need for vasopressor/MV. However, unfavorable medical histories and the severity of physiologic changes may be associated with short-term mortality to a greater extent than the single value of initial lactate.
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We describe emergency physician staffing, capabilities, and academic practices in US Veterans Health Administration (VHA) emergency departments (EDs). ⋯ Veterans Health Administration emergency physicians have primarily clinical responsibilities, and less than half have formal emergency medicine board certification. Despite most VHA EDs having university affiliations, traditional academic activities (eg, teaching and research) are performed in only 1 in 3 VHA EDs. Less than half of VHA EDs have availability of consulting services, including advanced stroke care and women's health.
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The objective was to determine the feasibility of "rapid" magnetic resonance imaging (rMRI) versus noncontrast computed tomography (NCCT) for pediatric patients with possible traumatic brain injury and to compare the populations receiving imaging in an urban tertiary care emergency department ED. ⋯ Rapid MRI may be a viable imaging modality for moderate-risk pediatric head injury. Although rMRI took longer to obtain during this pilot study, scan time was only 3 to 4 minutes; and LOS was only 41 minutes longer. Further integration of rMRI in patient care should decrease time variation. Future study of rMRI reliability and satisfaction is needed.
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Observational Study
Performance of an expedited rhythm control method for recent onset atrial fibrillation in a community hospital.
A standard approach to recent onset atrial fibrillation (AF) in the emergency department (ED) in the United States has not been established. ⋯ An ED protocol that uses rhythm control decreased hospital admission and LOS, and there were no adverse events at 30 days.