The American journal of emergency medicine
-
Comparative Study
A comparison of call volumes before, during, and after Hurricane Harvey.
There is currently minimal data regarding the demand placed on Emergency Medical Services in the wake of hurricanes and other natural disasters. This retrospective review provides an opportunity to analyze call volumes to EMS and their distribution before, during, and after Hurricane Harvey in one area on the Texas Gulf Coast. ⋯ EMS and emergency departments can expect peak volumes in the last days of a natural disaster as well as the first few days after the event with increases in injuries, general pain, respiratory distress, chest pain, and generalized weakness. EMS education, proper hospital staffing, and increased telemedicine/community paramedicine usage presents opportunities to increase efficiency in community healthcare during natural disasters.
-
To examine the association between cerebrospinal fluid (CSF) cultures and blood cultures in patients with suspected bacterial or fungal meningitis. ⋯ Our results suggest an insufficient degree of agreement between CSF and blood culture results. PCR may be a prudent approach in patients requiring immediate antibiotics and delayed LP.
-
Case Reports
Acute myocardial infarction in the setting of left bundle branch block: Chapman's sign.
Acute myocardial infarction (AMI) diagnosis in patients with pre-existing left bundle branch block (LBBB) can be difficult. Undiagnosed or delayed diagnosis of AMI in these patients can put them at risk of having shock, mechanical complications, and death. We present a case of 77-year-old Caucasian male with a known LBBB and coronary artery bypass surgery for coronary artery disease who presented to the emergency department with a chief complaint of chest pain and shortness of breath. ⋯ Troponin levels were initially normal, but serial troponin showed elevated enzyme giving evidence of acute coronary syndrome (ACS). The patient was started on heparin drip and underwent subsequent coronary catheterization. Physicians should be aware of Chapman's sign on ECG in patients presenting with chest pain who have baseline LBBB as it might represent myocardial ischemia and warrant emergent treatment for ACS.
-
Mechanical ventilation can cause deleterious effects on the lung and thus alter patient's prognosis. The aim of this study was to describe the characteristics of prehospital mechanical ventilation in patients with septic shock requiring mechanical ventilation in the prehospital setting. ⋯ In this retrospective study, we observed an association between mortality at day 28 and prehospital VTIBW in pre-hospital mechanically ventilated patients with septic shock. A VTIBW <8 ml·kg-1 was associated with a decrease and a VTIBW >8 ml·kg-1 with an increase in mortality.
-
Emergency Department Observation Units (Obs Units) provide a setting and a mechanism for further care of Emergency Department (ED) patients. Our hospital has a protocol-driven, type 1, complex 20 bed Obs Unit with 36 different protocols. We wanted to understand how the different protocols performed and what types of care were provided. ⋯ An Obs Unit can care for a wide variety of patients who require multiple consultations, procedures, and care coordination while maintaining an acceptable length of stay and admission rate.