The American journal of emergency medicine
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Multicenter Study
Impact of an individual plan of care for frequent and high utilizers in a large healthcare system.
"Frequent or High Utilizers" are significant stressors to Emergency Departments (EDs) and Inpatient Units across the United States (US). These patients incur higher healthcare costs with ED visits and inpatient admissions. Our aims were to determine whether implementation of individualized care plans (ICPs) could 1) reduce costs, 2) reduce inpatient length of stay (LOS), and 3) reduce ED encounters throughout a large healthcare system. ⋯ Implementation of individualized care plan can reduce cost, inpatient LOS, and ED encounters for high utilizers.
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Randomized Controlled Trial Comparative Study
Flexible nasotracheal intubation compared to blind nasotracheal intubation in the setting of simulated angioedema.
Nasotracheal intubation is rarely performed in the emergency department (ED) but may be required in specific situations such as angioedema. Both blind and flexible nasal intubation (FNI) may be utilized; however, the preferred technique is unknown. ⋯ FNI and blind nasal intubation require similar time to intubation in this simulated model of angioedema.
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Letter Clinical Trial
Use of the PEPTEST™ tool for the diagnosis of GERD in the Emergency Department.
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Isolated motor disturbances in the paediatric population are uncommon presentations to the emergency department. Choreiform movements have a broad differential diagnosis and may present insidiously with progressive worsening of asymmetric clumsiness, hypotonia and dysarthria. The incidence of Sydenham's chorea (SC) caused by acute rheumatic fever (ARF) is very rare in developed countries. ⋯ We explore current literature regarding the various presentations of ARF, differential considerations in acute chorea, and diagnostic studies needed to determine the etiology of acute chorea. With the low incidence of chorea in developed nations, this diagnosis can be easily overlooked. We highlight the importance of this diagnosis, as well as primary and secondary treatment in ARF.
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Case Reports
Toluene toxicity presenting with hypokalemia, profound weakness and U waves in the electrocardiogram.
We present the case of a 25-year-old man with progressive limb weakness. His electrocardiogram showed prominent U waves which made us consider hypokalemia. ⋯ The approach to a patient with acute weakness can be challenging. This case reminds us that the electrocardiogram can be a valuable tool in the evaluation and differential diagnosis of patients presenting to the emergency department with these conditions.