The American journal of emergency medicine
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Geriatric problems frequently go undetected in older patients in emergency departments (EDs), thus increasing their risk of adverse outcomes. We evaluated a novel emergency geriatric screening (EGS) tool designed to detect geriatric problems. ⋯ The novel EGS is feasible, identifies previously undetected geriatric problems, and predicts determinants of subsequent care.
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The aims of this study were (a) to determine the prehospital prevalence of electrocardiographic (ECG) signs of acute myocardial ischemia in patients with suspected acute coronary syndrome and (b) to describe the relationships between the various ECG patterns and the diagnosis of acute myocardial infarction (AMI) and outcomes. ⋯ Among patients with a clinical suspicion of AMI in the prehospital setting, the prevalence of ECG signs suggesting AMI was low, as was the ability to identify AMI patients using ECG findings only. We therefore need better instruments in the prehospital triage of patients with acute chest pain.
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Comparative Study
Clinical evaluation compared to the pulse indicator continuous cardiac output system in the hemodynamic assessment of critically ill patients.
The objective was to assess the effects of pulse indicator continuous cardiac output catheterization on the management of critically ill patients and the alteration of therapy in intensive care units. ⋯ The hemodynamic variables obtained from pulse indicator continuous cardiac output catheterization improved the accuracy of bedside evaluations and led to alterations in therapeutic plans, particularly among the moderately ill patients with hypotension or unknown diagnoses.
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Stratifying risk of patients with acute coronary syndrome (ACS) in the emergency department (ED) remains a frequent challenge. When ST-elevation criteria are absent, current recommendations rely upon insensitive and time-intensive methods such as the electrocardiogram and cardiac enzyme testing. Here, we report on a series of cases, where emergency physicians used a simplified model for identifying regional wall motion abnormalities by point-of-care echocardiography in patients presenting with chest pain to the ED. With the use of a simplified model described herein, high-risk patients with ACS were identified rapidly in a cohort usually difficult to risk stratify.