The American journal of emergency medicine
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The purpose of this study is to consider the perceptions of rescuers of ACD operation and their anatomy characteristics are evaluated to yield a better understanding on operation of ACD. A prospective, descriptive study to evaluate professional providers received ACD training. A total of 39 emergency medical professional participated in this study. ⋯ In addition, women might operate ACD more difficultly. Modifying the operation of ACD (such as by putting a blanket put under the rescuer's knee or using footstool) was recommended and seems reasonable. These issues should be addressed on training.
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The purpose of this study was to investigate ED resource demand during periods of Centers for Disease Control and Prevention (CDC)-declared widespread influenza activity (WIA). An observational analysis of secondary data describing ED resource demand was performed using computerized ED patient data over a 130-week period. Measures of ED resource utilization were compared during WIA and non-WIA periods. ⋯ An association between WIA and greater ED resource demand was observed. A spike in census was observed at the onset of each WIA period. In addition, the flu index increased during WIA, suggesting the use of the ED as a site for syndromic surveillance of WIA onset.
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Spontaneous coronary artery dissection is an unusual cause of acute coronary syndrome. We describe a series of cases that with an early diagnosis and aggressive treatment, which includes percutaneous angioplasty with stent implantation and cardiac surgery, had a good outcome. The objective was to study the demographic characteristics, clinical settings, treatments, and inhospital course of patients with spontaneous coronary artery dissection. ⋯ Spontaneous coronary artery dissection remains an unusual cause of acute coronary syndrome. It should be included in the differential diagnosis of acute myocardial infarction, especially when it affects young, healthy females. An early clinical suspicion and diagnosis with urgent coronary angiography and aggressive treatment that includes percutaneous angioplasty with stent implantation and cardiac surgery could improve the prognosis of these patients.
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The objective of this study was to survey the use of observation units (OUs) in the United States. A written survey was mailed to every third hospital (sequential by zip code) in the United States. ⋯ Those hospitals that had OUs had a higher overall ED census, higher rate of diversion of ambulances, and were more likely to be in metropolitan areas (P <.05), but there was no relationship to payor mix or to ED hospital admission rate. The OUs were characterized by a mean 4.8 years in existence, 57.3% ED administratively responsible, 59.4% ED clinically responsible, a mean of 1330 patients per year, an average length of stay of 15.3 hours, a 4.2 nurse-to-patient ratio, and 22.3% hospital admission rate.
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We report 3 cases of myoclonus associated with etomidate during ED procedural sedation and analgesia (PSA). EPs should be familiar with myoclonus associated with etomidate. Clinicians using this drug for PSA should be prepared to offer the brief period of support, and occasionally, respiratory assistance, required when etomidate-associated myoclonus is encountered.