The American journal of emergency medicine
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Admission on weekends and off-hours has been associated with poor outcomes and mortality from acute stroke. The purpose of this study was to investigate whether an organized clinical pathway (CP) for ischemic stroke can effectively reduce the time from arrival to evaluation and treatment in the emergency department (ED) and improve outcomes, regardless of the time from arrival in the ED. ⋯ An organized CP, based on CPOE, for ischemic stroke can effectively attenuate disparities in the time interval between ED arrival to evaluation and treatment regardless of ED arrival time. This pathway may also help to eliminate off-hour and weekend effects on outcomes from ischemic stroke.
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Comparative Study Clinical Trial
A comparison of the supraclavicular and infraclavicular views for imaging the subclavian vein with ultrasound.
Ultrasound guidance for central line placement in the subclavian vein (SCV) is more efficient and safer than landmark-based technique. The supraclavicular (SC) approach is an alternative to the infraclavicular (IC) approach, but the research is sparse. The objective was to determine which approach provides the best view. ⋯ The SC approach allows for a better view of the SCV on ultrasound than the IC approach. Future research should determine if this translates to a greater success rate when placing central lines in the SCV.
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Compare outcomes among emergency department (ED) patients with low-positive (0.01-0.02 ng/mL) vs negative troponin T. ⋯ Among patients not initially admitted, rates of death and coronary revascularization differed insignificantly at 30 days but significantly at 6 months. Detailed inspection of our results reveals that the bulk of the added risk at 6 months was due to non-cardiac mortality.