The American journal of emergency medicine
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The aim of this study was to investigate the relationship between the optic nerve sheath diameter (ONSD) measured on non-contrast head computed tomography (CT) and the diagnosis and prognosis of spontaneous subarachnoid hemorrhage (SAH) on emergency department (ED) patients. ⋯ In patients with spontaneous SAH, the ONSD measured in the orbital sections of a head CT is strongly correlated with a SAH diagnosis. Assessment of ONSD in head CTs taken with spontaneous SAH suspicion may contribute to the diagnoses of spontaneous SAH.
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Point-of-care cardiac ultrasound (POCUS) is a common application in Emergency Medicine. Here we present a case of an incidentally discovered dilated right coronary sinus on ultrasound. This case involved a 55-year-old female who presented with chest pain, shortness of breath, and lightheadedness. ⋯ It is a tubular structure located at the posterior atrioventricular groove and it is generally not visible unless it is pathologically dilated. Identification of a dilated right coronary sinus can assist the clinician in making the diagnoses of CHF exacerbation, as well as alter the approach to specific procedures. To the best of our knowledge, this is the first case report describing the identification of a dilated right coronary sinus using POCUS.
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Observational Study
Effects of repeated epinephrine administration and administer timing on witnessed out-of-hospital cardiac arrest patients.
Repeated administration of epinephrine is associated with unfavorable cerebral outcome after out-of-hospital cardiac arrests (OHCA), but the timing of epinephrine administration has not been considered. ⋯ Repeated epinephrine administration improved CPC 1-2 outcome when epinephrine was administrated within 20min after an emergency call for witnessed cardiogenic OHCA.
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This study aims to investigate the role of the blood pressure index (BPI), which is a new index that we developed, in detection of right ventricular dysfunction (RVD) in acute pulmonary embolism (APE). ⋯ We found that BPI was an index with high positive predictive value and low negative predictive value in detection of RVD.
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Observational Study
Describing wait time bottlenecks for ED patients undergoing head CT.
Facing increased utilization and subsequent capacity and budget constraints, ED's must better understand bottlenecks and their effect on process flow to improve process efficiency. The primary objective of this study was to identify bottlenecks in obtaining a head CT and investigate patient waiting time based on those bottlenecks. ⋯ Demand capacity mismatch in head CT scanning has a significant impact on patient waiting times. This study suggests opportunities to improve wait times through future research to understand the causes of delays in CT ordering, CT completion and timeliness of radiology reports.