The American journal of emergency medicine
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Dysphagia is a common problem for patients after an acute stroke which can lead to hospital acquired pneumonia (HAP) increasing morbidity and mortality. The Joint Commission has directed that stroke certified hospitals perform a dysphagia screen at the time of initial presentation. We sought to evaluate if our ED dysphagia screen was correlated with lower rates of pneumonia in acute stroke patients. ⋯ The use of our ED dysphagia screen was associated with a significant reduction in the rates of HAP in both ischemic and hemorrhagic stroke patients. Given the high rates of dysphagia and significant comorbidity and complications for these stroke patients, the use of a screen is warranted.
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Peri-mortem caesarean section (PMCS) is a very rare procedure performed to improve the chances of survival for both mother and fetus following cardiorespiratory arrest. Non-obstetricians including Emergency Physicians (EPs) are often called upon to perform this procedure under challenging and suboptimal circumstances. We reported a case of PMCS performed timely after traumatic cardiorespiratory arrest that resulted in fetal survival. ⋯ She survived and is currently one year old. The mother, however, did not respond to our resuscitation and succumbed to her multiple injuries. We reviewed the limited literature regarding this potentially life-saving emergency procedure and highlighted the challenges facing our resuscitation team.
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Investment in violence prevention programs is hampered by lack of clearly identifiable stakeholders with a financial stake in prevention. We determined the total annual charges for the acute care of injuries from interpersonal violence and the shift in financial responsibility for these charges after the Medicaid expansion from the Affordable Care Act in 2014. ⋯ After Medicaid expansion, taxpayers are now accountable for nearly half of the $10.7 billion in annual charges for the acute care of violent injury in the U.S. These findings highlight the benefit to state Medicaid programs of preventing interpersonal violence.
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To investigate the impact of short-term exposure to air pollutants and meteorological variation on ED visits for primary spontaneous pneumothorax (PSP). ⋯ Increased concentrations of air pollutants and abrupt change in atmospheric pressure were significantly associated with increased IRR of PSP.