The American journal of emergency medicine
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Delirium in older emergency department (ED) patients is associated with severe negative patient outcomes and its detection is challenging for ED clinicians. ED clinicians need easy tools for delirium detection. We aimed to test the performance criteria of the modified Richmond Agitation Sedation Scale (mRASS) in identifying delirium in older ED patients. ⋯ The sensitivity of the mRASS to detect delirium in older ED patients was low, especially in patients with dementia. Therefore its usefulness as a stand-alone screening tool is limited.
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A 36 year old male presented to the emergency department with severe epigastric pain, nausea, vomiting without hematemesis, diarrhea and anorexia. He presented with respiratory distress, shock and fever at the emergency. He was intubated and shifted to the intensive care unit with the diagnosis of acute pancreatitis with hypercalcemia and an elevated amylase and lipase's well as thrombocytopenia and elevated creatinine. ⋯ The typical presentation of multiple myeloma is anemia, back pain, and an elevated sedimentation rate. Patients with multiple myeloma have hypercalcemia but it's rarely manifested as acute pancreatitis. This case shows a rare presentation of multiple myeloma as acute pancreatitis in a younger adult.
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Comparative Study
Comparison of urinary tract infection antibiograms stratified by emergency department patient disposition.
Institutional antibiograms guide Emergency Department (ED) clinicians' empiric antibiotic selection. For this study, we created and compared antibiograms of ED patients stratified by disposition (admitted or discharged). ⋯ We found higher antibiotic sensitivities in ED-Only than the IP-Only Study-Specific Antibiograms. Our Study-Specific Antibiograms offer an alternative guide for antibiotic selection in the ED.
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Migraine and subarachnoid hemorrhage (SAH) patients present to emergency departments with the similar symptoms as headache, nausea, and vomiting. This study investigated whether the neutrophil-lymphocyte ratio (NLR) could distinguish patients with SAH from those with migraine. ⋯ In this retrospective analysis, NLR distinguished patients with SAH from those with migraine. Presence of SAH should be evaluated from discharged and readmitted patients (with headache symptoms) when an increase in NLR between initial and readmission levels is observed.
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Letter Multicenter Study
A program of education and performance feedback reduces CT ordering in the emergency department.