The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study
Comparison of chest compression interruption times across 2 automated devices: a randomized, crossover simulation study.
The goal of this study was to compare chest compression interruption times required to apply, adjust, and remove 2 different automated chest compression (ACC) devices using the same evaluation protocol. ⋯ The results of this study trended in favor of AutoPulse. However, the interruption in chest compression to apply either device to the patient was notably longer than the maximum interruption time recommended by the American Heart Association.
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Randomized Controlled Trial
Utility of gum-elastic bougie for tracheal intubation during chest compressions in a manikin: a randomized crossover trial.
The utility of the gum-elastic bougie (GEB) as an assistive device for tracheal intubation during chest compressions has not been sufficiently validated. This study aimed to compare the utility of the GEB during chest compressions on an adult manikin. ⋯ These findings suggest that the GEB facilitates tracheal intubation during chest compressions performed by novice physicians in adult simulations.
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Prehospital pediatric airway management is difficult and controversial. Options include bag-mask ventilation (BMV), endotracheal tube (ETT), and laryngeal mask airway (LMA). Emergency Medical Services personnel report difficulty assessing adequacy of BMV during transport. Capnography, and capnograph tracings in particular, provide a measure of real-time ventilation currently used in prehospital medicine but have not been well studied in pediatric patients or with BMV. Our objective was to compare pediatric capnographs created with 3 airway modalities. ⋯ Capnographs are generated during BMV and are virtually identical to those produced with ETT or LMA ventilation. Attention to capnographs could improve outcomes during emergency treatment and transport of critically ill pediatric patients requiring ventilation with any of these airway modalities.
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We examined trends in the use of observation services and the relationship between index service type (observation services, emergency department [ED] visits, inpatient stays) and both clinical outcomes and Medicare payments. ⋯ Patients treated in observation are less likely than those treated in the ED or as inpatients to have an adverse event within 30 days. Adjusted Medicare payments, including the index stay and the subsequent 30 days, were substantially less for those treated in observation as compared with those treated as inpatients, but more than for those treated and released from the ED. Higher rates of observation service use do not appear to be negatively affecting patient outcomes and may lower costs relative to inpatient treatment.
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Observational Study
Assessing patient activation and health literacy in the ED.
Low health literacy and patient activation are linked to unmet health needs, excess emergency department (ED) use, and hospital admission. However, most studies have assessed these measures in non-ED populations. ⋯ This is the first study to assess Patient Activation Measure in the ED. Low activation levels and limited REALM scores assessed in the ED population were significantly associated with hospital admission. Assessing activation levels of ED patients could lead to better education and tailored discharge planning by ED clinicians potentially reducing ED revisits.