The American journal of emergency medicine
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Multicenter Study
Variations in access to specialty care for children with severe burns.
Pediatric burns account for 120,000 emergency department visits and 10,000 hospitalizations annually. The American Burn Association has guidelines regarding referrals to burn centers; however there is variation in burn center distribution. We hypothesized that disparity in access would be related to burn center access. ⋯ The majority of children who met criteria were treated at burn centers. There was no significant difference between geographical regions. Of those who were treated at burn centers, more severe injury patterns were noted, but there was no significant mortality difference. Further study of optimal referral of pediatric burn patients is needed.
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Comparative Study
Comparison of emergency department to hospital antibiograms: Influence of patient risk factors on susceptibility.
Traditional antibiograms use local resistance patterns and susceptibility data to guide empiric antimicrobial therapy selection. However, antibiograms are rarely unit-specific and do not account for patient-specific risk factors. ⋯ There were no statistically significant differences between the ED and hospital antibiogram with the exception of Escherichia coli. However, development of an ED-specific antibiogram can aid physicians in prescribing appropriate empiric therapy when risk factors are included.
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Coagulation panels are ordered for a variety of conditions in the emergency department (ED). ⋯ Little utility for coagulation assessment is present for the evaluation of chest pain, routine perioperative assessment, initiation of anticoagulation, and screening for admitted patients. However, coagulation panel assessment should be considered in patients with hemorrhage, patients on anticoagulation, and personal history or family history of bleeding.
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Hands-on defibrillation (HOD) is a technique that has great potential to positively impact outcomes from cardiopulmonary resuscitation (CPR) with the removal of an interruption in chest compressions. The safety and efficacy of HOD, however, have yet to be proven. This review aims to examine the safety of HOD, and secondarily, its efficacy. ⋯ HOD generally appears safe, though significant uncertainty still remains for each protective barrier type. HOD appears to be efficacious in improving CPR with no strong evidence to suggest otherwise.