The American journal of emergency medicine
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Comparative Study
Central venous saturation in septic shock: co-oximetry vs gasometry.
Central venous oxygen saturation calculated by gasometry (Gaso-Scvo2) is more available than central venous oxygen saturation measured by co-oximetry (Co-oxy-Scvo2) in environments with less resources and underdeveloped countries. Therefore, we aimed to determine the agreement between Co-oxy-Scvo2 and Gaso-Scvo2 and between central venous oxygen tension measured by gasometry (Gaso-Pcvo2) and Co-oxy-Scvo2, respectively. ⋯ The reliability of Gaso-Scvo2 determination during the resuscitation phase of septic shock is not acceptable. There is a good agreement between a Gaso-Pcvo2 more than 40 mm Hg and a Co-oxy-Scvo2 greater than or equal to 70%. Our results suggest that given these limitations, Gaso-Scvo2 results should be interpreted with caution, helped by Gaso-Pcvo2 measurements and in context with other perfusion parameters.
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Observational Study
The inaccuracy of determining overcrowding status by using the National ED Overcrowding Study Tool.
Emergency department (ED) crowding has become more common, and perceptions of crowding vary among different health care providers. The National Emergency Department Overcrowding Study (NEDOCS) tool is the most commonly used tool to estimate ED crowding but still uncertain of its reliability in different ED settings. ⋯ Using the NEDOCS tool to determine ED crowding might be inaccurate in an extremely high-volume ED setting.
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We initiated a program to rapidly rule out myocardial infarction and make an appointment (with no co-payment) with a cardiologist within 72 hours for patients with low-risk chest pain. ⋯ This program did not reduce repeat ED visits. Patients with insurance were more likely to keep follow-up appointments.
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Observational Study
Risk factors associated with difficult venous access in adult ED patients.
The objective was to determine risk factors associated with difficult venous access (DVA) in the emergency department (ED). ⋯ Nearly 1 of every 9 to 10 adults in an urban ED had DVA. Diabetes, IV drug abuse, and sickle cell disease were found to be significantly associated with DVA.
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To determine how age and gender impact resource utilization and profitability in patients seen and released from an Emergency Department (ED). ⋯ Resource utilization increased and profitability decreased with increasing age in patients seen and released from an ED. The care of women of childbearing age resulted in higher resource utilization and higher profitability than men of the same age. No differences in resource utilization or profitability by gender were observed in children and adults over 45.