The American journal of emergency medicine
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Pre-hospital triage with ECG-transmission may reduce time to reperfusion in patients with ST-elevation acute myocardial infarction (STEMI). Less, however, is known on potential benefit of ECG-transmission triage in mountain areas, with complex orography. ⋯ Pre-hospital triage with ECG-transmission is associated with shorter ischemic time even in mountain areas with a complex orography profile. The benefit is greater in elderly patients and remote areas.
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To estimate the association between adopting emergency department (ED) crowding interventions and emergency departments' core performance measures. ⋯ Majority of interventions did not significantly associated with ED' core performance measures.
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Case Reports
Second-degree atrioventricular block in an adolescent with an acute alcohol intoxication.
Binge drinking adolescents often present to the emergency department with an alcohol intoxication. Known clinical signs of alcohol intoxications are impaired consciousness and vomiting, occasionally complicated by pulmonary aspiration. ⋯ We present a case of a second-degree AV block in an adolescent with an acute alcohol intoxication. The etiology of this condition is not well understood; possible explanations are reviewed in this manuscript.
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Observational Study
The impact of an emergency care access point on pediatric attendances at the emergency department: An observational study.
Crowding is a growing concern in general and pediatric Emergency Departments (EDs). The Emergency Care Access Point (ECAP) - a collaboration between general practitioners and the ED - has been established to reduce the number of self-referrals and non-urgent ED visits. The aim of this study was to determine the impact of an ECAP on pediatric attendances in the ED. ⋯ The implementation of an ECAP was associated with a reduction of pediatric ED use, including a considerable but expected decline in pediatric self-referrals. Patient acuity pre- and post-ECAP was similar. Our results suggest that this primary care intervention might help reduce the workload in a pediatric ED. Future studies are warranted to further investigate this hypothesis and to evaluate the impact of an ECAP in other healthcare settings. These future efforts need to include patient oriented outcomes.
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Rapid estimates of the central venous pressure (CVP) can be helpful to administer early fluid therapy or to manage cardiac preload in intensive care units, operating rooms or emergency rooms in order to start and monitor an adequate medical therapy. Invasive CVP measurements have inherent and non-negligible complication rates as well as great expenditures. Several noninvasive methods of CVP measurements, like ultrasound-guided techniques, are available, but require trained skills and special equipment which might not be at hand in all situations. ⋯ A high HVC had a sensitivity of 29% but a high specificity of 94% for a high CVP. The overall performance of observing the hand vein collapse to estimate CVP was only moderate in the intensive care setting. However, the median difference to the CVP was low and HVC identifies a low CVP with a high sensitivity and excellent negative predictive value.