The American journal of emergency medicine
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Operational data are often used to make systems changes in real time. Inaccurate data, however, transiently, can result in inappropriate operational decision making. Implementing electronic health records (EHRs) is fraught with the possibility of data errors, but the frequency and magnitude of transient errors during this fast-evolving systems upheaval are unknown. This study was done to assess operational data quality in an emergency department (ED) immediately before and after an EHR implementation. ⋯ This single-center study raises questions about operational data quality in the peri-implementation period of EHRs. Using electronic timestamps for operational assessment and decision making following implementation should recognize the magnitude and compounding of errors when computing service times.
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Case Reports
LUCAS 2™ device, compression depth, and the 2010 cardiopulmonary resuscitation guidelines.
The 2010 guidelines for cardiopulmonary resuscitation recommends that the chest be compressed at least 5 cm, with evidence that depths exceeding 5 cm may further aid resuscitation. The current piston-based mechanical device LUCAS 2™ is programmed to deliver a compression depth of 5 cm. ⋯ These cases depict limitations of the LUCAS 2™ device and the importance of guiding chest compression by physiological parameters. Consideration should be given to modifications to the LUCAS 2™, allowing rescuers to increase depth when required to optimize the hemodynamic efficacy of chest compression.
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Vibrio vulnificus causes potentially life-threatening and rapidly progressing infections. Therefore, the severity-of-illness assessment appears to be important for V vulnificus-infected patients at the time of admission. The aim of our study was to evaluate the performance of the severity-of-illness scoring model on admission in V vulnificus-infected patients. ⋯ The REMS could provide clinicians with an effective adjunct risk stratification tool for V vulnificus-infected patients.
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The aim of this study is to determine the prevalence of cardiac disease and its relationship to the victim's probable intent among patients with cardiac arrest due to drowning. ⋯ Among 2166 autopsied cases of drowning, more than half were considered to be accidental, and less than one-third, suicidal. Among accidents, 14% were found to have a cardiac disease as a possible contributory factor; among suicides, the proportion was 0%. The low proportion of cases showing ventricular fibrillation was similar, regardless of the presence of a cardiac disease.
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Case Reports
Lipid emulsion therapy in cardiodepressive syndrome after diltiazem overdose--case report.
We present a case of diltiazem overdose in which the patient ingested 5.6 g in an apparent suicide attempt. She was admitted in the emergency department 2 hours postingestion with cardiodepressive syndrome. She was treated with gastric lavage, activated charcoal, intravenous fluids, calcium, and epinephrine, without improvement in vital signs. ⋯ The patient was stable hemodynamically and metabolic in the following 24 hours. She was alert and oriented and was extubated in the second day. She was discharged after 4 days in a good state and without any neurologic deficits.