The American journal of emergency medicine
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Comparative Study
Comparison of qSOFA score and SIRS criteria as screening mechanisms for emergency department sepsis.
The Quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) score has been shown to accurately predict mortality in septic patients and is part of recently proposed diagnostic criteria for sepsis. We sought to ascertain the sensitive of the score in diagnosing sepsis, as well as the diagnostic timeliness of the score when compared to traditional systemic inflammatory response syndrome (SIRS) criteria in a population of emergency department (ED) patients treated in the ED, admitted, and subsequently discharged with a diagnosis of sepsis. ⋯ Although qSOFA may be valuable in predicting sepsis-related mortality, it performed poorly as a screening tool for identifying sepsis in the ED. As the time to meet qSOFA criteria was significantly longer than for SIRS, relying on qSOFA alone may delay initiation of evidence-based interventions known to improve sepsis-related outcomes.
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Esophageal perforation due to blunt trauma is a rare clinical condition, and the diagnosis is often difficult because patients have few specific symptoms. Delayed diagnosis may result in a fatal clinical course due to mediastinitis and subsequent sepsis. ⋯ Therefore, the patient developed septic shock due to mediastinitis. However, his subsequent clinical course was good because of prompt combined therapy involving surgical repair and medical treatment after the diagnosis.
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The use of ultrasonography for the investigation of pneumomediastinum is limited by the presence of air artifacts. Air accumulation in the mediastinum obscures the heart, sometimes leading to misinterpretation as lung tissue. ⋯ We named this dynamic finding, the "disco spotlight" sign. This finding may be useful to confirm the diagnosis of pneumomediastinum.
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It is unclear whether scene time interval (STI) is associated with better neurological recovery in the emergency medical service (EMS) system with intermediate service level. ⋯ The middle STI (4-7min) was associated with the highest odds of neurological recovery for patients who could not be restored in the field. The STI may be a clinically useful predictor of good neurology outcome in victims of cardiac arrest.
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In-hospital cardiac arrests (IHCAs) are often preceded by abnormal vital signs. Preceding abnormal vital signs might lower the physiological reserve capacity and therefore decrease survival after an IHCA. ⋯ The NEWS can be a probable proxy for estimating physiological reserve capacity since high NEWS is associated to high change of death in case of an IHCA. This information can be used when discussing prognosis with patients and relatives. But even more importantly, it stresses the need for better preventive strategies in IHCAs. STRENGTHENS AND LIMITATIONS WITH THIS STUDY.